Primary splenic angiosarcoma: a rare case of embolization as a bridge to splenectomy

Abstract

Primary splenic angiosarcoma is the primary malignant vascular neoplasm of the spleen. This tumor is highly aggressive and extremely rare with a nonspecific clinical presentation. Prognosis is poor and almost all patients die within one year of diagnosis. We present the case of a 69-year-old healthy woman with left-sided abdominal tenderness. An ultrasound examination of the abdomen was performed to evaluate the cause of abdominal pain and showed splenomegaly with inhomogeneous echotexture and the presence of free intraperitoneal fluid. An emergency abdominal contrast-enhanced computed tomography confirmed the splenomegaly and showed hemoperitoneum and a splenic mass with heterogeneous contrast enhancement. Due to the sudden worsening of the patient’s clinical conditions (hemoglobin level of 7 g/dl) and the unavailability of the operating room, embolization of the splenic artery was performed as a bridge to subsequent splenectomy under the suspicion of splenic rupture. Histological examination demonstrated a primary splenic angiosarcoma and the patient was referred to an oncological center. Due to the rarity of this malignancy, the optimal treatment of primary splenic angiosarcoma remains under investigation. Transcatheter splenic artery embolization is not common, but it could be useful for temporarily stabilizing the patient as a bridge to the subsequent splenectomy.