LETTER TO THE EDITOR Angiosarcoma of the liver with metastasis to the cervical spine cured with the treatment of thalidomide and radiotherapy Selim Kayaci & Ozcan Yildiz & Hasan Gucer & Nil Molinas Mandel Received: 30 April 2011 / Accepted: 27 September 2011 / Published online: 14 October 2011 # Springer-Verlag 2011 Dear Editor, We would liketo presenta uniquecaseof metastatic angiosarcoma of the cervical spine treated with thalidomide. A 62-year-old malepatientpresented at the general surgeryoutpatientclinic with pain in his backand epigastricarea,which had lasted for severaldays.On examination, epigastric tenderness was noted and the liver was palpable. There were extralobular growths adjacent to the vascular structures on the abdominal magnetic reso- nance imaging (MRI). A biopsy was taken from the masses thatlargely occupied the left lobe of the liver. Histopath- ologicalexamination revealed infiltration of the hepatic tissue with epitheloid-like cells thathad large vesicular nucleiand eosinophilic cytoplasms, and with proliferating tumourcells with mitoticactivity.Angiosarcoma was diagnosed according to above pathological findings.The patient declined a second operation, which was recommen ded for the removal of the remaining part of the tumour. It was decided to treat the patient with thalidomide afte the consultation with the medical oncologists, as there ha been several published reports concerning its anti-tumour effects, including inhibition of cytokines and angiogenesis, immunomodulation and induction of apoptosis [ 1]. After 3 monthsof treatment (600 mg of thalidomide/day), a significantregression in thetumourmasswasnoted. Haematological parameters were measured every 3 month while upper abdominal MRI scans were obtained every 6 months, during the course of medical treatment. One year later the patient developed a pain in the left shoulder, whi was radiating down the left arm that was numb and weak. Neurological examination revealed hypothenar atrophy an C6, 7, and T1 hypoesthesia. The cervical MRI scan showed a contrast-enhanced lesion in the seventh cervical body, le pedicle and left posterior arch, which were consistent with metastatic lesion (Fig. 1). Radiotherapy was planned. A daily dose of 4 Gy for 13 days was administered to the cervicothoracic area with the result of significant regressio of the tumour. A daily 600-mg dose of thalidomide was continued for 2 years, followed by a 2-year daily dosage o 300 mg. Hepatic angiosarcoma, also known as hemangiosarcom is an extremely rare malignant tumour and represents 1-3 of all primary livercancers[ 4]. It develops from liver endothelial cells,and occurs in adult age groups with a peak incidence in the 6th and 7th decades. The prognosis angiosarcoma is very poor and patients usually die within year [2]. A haemorrhagic mass in the liver should be considered as being either a hemangioma, hepatoma, or metastatic lesion [3].Sixty percent of patientswith angiosarcomas havemetastasis at the time of diagnosis. Our patient S. Kayaci (*) Department of Neurosurgery, School of Medicine, Rize University, Rize 53100, Turkey e-mail: selim_kayaci@hotmail.com O. Yildiz : N. M. Mandel Department of Oncology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey O. Yildiz e-mail: ozcanyildiz71@gmail.com N. M. Mandel e-mail: nmmandel@gmail.com H. Gucer Department of Pathology, School of Medicine, Rize University, Rize,Turkey e-mail: hasan_gucer@yahoo.com Acta Neurochir (2012) 154:369–370 DOI 10.1007/s00701-011-1192-1