Ruptured primary splenic angiosarcoma into the colon. Presentation as analbleeding

A 71-year-old woman presented with a six month history of constipation and abdominal discomfort, with anal bleeding during the last days. Ultrasonogra phy and CT-scan of the abdomen showed a large heterogeneous mass that was l ocated in the splenic region, but the nature and origin of the tumour could not be clearly established preoperatively. The clinical diagnosis was of a bdominal tumour with colonic and splenic involvement, and a left hemicolect omy and splenectomy were performed. Pathologic examination revealed a prima ry angiosarcoma of the spleen with penetration and fistulization of the tum our into the large bowel. The patient received adjuvant radiation therapy, but she died of extensive metastastic disease from her primary angiosarcoma of the spleen nine months after surgery. In summary, splenic angiosarcoma is very difficult to diagnose preoperative ly. This highly aggressive neoplasm has an overall poor prognosis, speciall y if it is associated with rupture and haemoperitoneum, As this case highli ghts, unusual forms of rupture may lead to atypical clinical presentations, increasing even more the difficulty in the diagnosis.