although splenic angiosarcoma has been presented as an extremely rare malignant tumour in medical literature spanning the last 20 years , an increasing number of cases have been identified over that same time period . some of these cases are typically identified upon spontaneous rupture of the organ ( 32% ) , and as such are associated with a poor prognostic outcome for the patient . despite tremendous strides undertaken in medicine over the last two decades , both conservative and invasive treatment measures continue to produce low - yield results when it comes to prolonging patient survival . this may likely be attributed to a high rate of distant metastasis , affecting organs such as the liver , breast and bone . only hara et al . have reported long - term survival of a patient with angiosarcoma after splenectomy , and high - dose chemotherapy , and autologous peripheral blood stem cell transplantation . we hereby report our experience with two splenic angiosarcoma cases , which despite being similar in their diagnosis , nonetheless presented with an entirely different clinical picture . both may be found in common practice , and ought to be highlighted for their significance . a 54-year - old caucasian man was initially admitted to the clinic of gastroenterology with non - specific complaints of abdominal pain and loss of appetite over the last 6 weeks , which grew worse post - prodigally and with respiration . laboratory results revealed normocytic anaemia ( haemoglobin 10.0 g / dl ) , reticulocytosis , thrombocytopenia ( platelets 68  10/l ) , a small increase in bilirubin ( 2.34 mg / dl ) , as well as elevated ldh ( 758 iu ) , ggt ( 200 iu ) and alp ( 336 iu ) levels . ultrasound was inconclusive , but revealed structural changes that corresponded to either the presence of metastasis or a haemangioma . a subsequent ct scan further elucidated an affected spleen , with possible metastatic or lymphoma - like changes ( fig . 1 ) . abdominal computed tomography scan demonstrating an en larged spleen with the metastatic liver tumours the patient was scheduled for explorative surgery , but prior to it being performed , he went into shock and presented with an ascitic abdomen . his subsequent morphological parameters were increasingly depressed when compared to their previous counterparts , and emergency ultrasound and ct scans showed a significant amount of peritoneal fluid . during the emergency surgery , approximately 3 litres of both old and fresh blood were discovered within the peritoneal cavity , along with a 16 cm cyst located in the spleen , which was also seeping blood . both lobes of the liver were covered with numerous small tumours , 2 of which were bleeding , as they sat interspersed between multiple blood clots . after suturing and a histological sample of the liver had been obtained , a splenectomy and peritoneal lavage with warm saline to evacuate the clots were performed , and the operation was concluded . a cross - section of the spleen subsequently revealed a greyish - white discharge , with the organ itself measuring 16  12  10 cm ( fig . a 77-year - old caucasian woman was admitted to our hospital due to haematochezia and fatigue . she initially presented at the clinic with a number of concurrent illnesses , chief amongst them being normocytic anaemia , diabetes mellitus type 2 , hypertension , and paroxysmal atrial fibrillation . having previously undergone a hysterectomy , the patient had now been referred for the operation . the spleen was visibly enlarged , and showed a number of superficial tumours . purpura - like changes were further noted atop the greater omentum , as well as the wall and mesentery of the small bowel ( fig . 3 ) . at the sigmoid portion of the colon , immediately above the colorectal junction , 4 ) . a resection of the sigmoid colon as well as the anterior portion of the rectum was undertaken , with an accompanying colorectal anastomosis . subsequent histological examination of the obtained samples evaluated them to be an adenocarcinoma of the sigmoid colon ( g2 , t3 ) , an angiosarcoma of the spleen ( g3 ) , as well as lymph nodes that were affected by metastasis ( fig . no complications were noted following the surgery , although the patient 's state was deemed to be less than ideal . her age and the concurrent presentation of two independent cancers excluded her from the possibility of receiving adjuvant chemotherapy . intraperitoneal dissemination of the splenic angiosarcoma carcinoma of the sigmoid colon the splenic angiosarcoma angiosarcoma with anastomosing vascular channels . tumour cells are large , polygonal with abundant eosinophilic cytoplasm and large nuclei with prominent eosinophilic nucleoli amongst the rarest of all neoplasms , primary splenic angiosarcoma has a frequency of 0.140.25 reported cases per one million persons annually [ 3 , 4 ] . no previous article has made mention of primary splenic angiosarcoma existing independently of another primary neoplasm . although jimenez - heffernan et al . ( 1999 ) have outlined the rupture of a splenic angiosarcoma into the colon  subsequently presenting as anal bleeding  they made no mention of the event occurring as a result of synchronous presentation of two primary tumours . more accurately , these results suggest that the affected splenic flexure was a site of a gi metastasis , rather than primary neoplastic involvement . as such , our case would be the first one to highlight the co - occurrence of a simultaneous adenocarcinoma of the colon and an angiosarcoma of the spleen . the clinical symptoms and diagnostic values associated with splenic angiosarcoma are extremely variable . nonetheless , the majority of patients ( 75% ) complain of abdominal pain , and a quarter to one - third present with rupture of the involved organ [ 312 ] . anaemia , leucopoenia , elevated ldh levels and thrombocytopenia are also frequently reported , with anaemia being caused by damage to the red cell surface , whilst the other factors may be precipitated by severe haemolysis . it has been increasingly postulated that thrombocytopenia may be the first manifestation of the disease , even in the absence of other laboratory irregularities . interestingly , while both cases are characterized by similarities when it comes to the values obtained in their laboratory results , the first patient had never suffered from any major illness prior to his presentation of splenic angiosarcoma , while the second had long been affected by a number of other illnesses . splenic angiosarcoma typically carries with it a grave prognosis for all but 20% of patients , who then manage to survive for a period longer than 6 months [ 4 , 6 ] . survival statistics are thought to be increased in those instances where the diagnosis and/or the splenectomy are performed prior to the actual rupture of the organ [ 3 , 11 ] . both cases were indeed marked by significant intraperitoneal bleeding , lending further support to the previously produced research . as in the case of the second patient , the co - existence of two independent tumours then coupled with an intraperitoneal haemorrhage appears to have decreased the survival rate even further . although typically described as rare , primary splenic angiosarcoma nonetheless carries with it an extremely low survival rate upon infection . it has an ever - changing clinical and laboratory profile , with no consideration for genetics , ethnicity , or geographical location . its diagnostic evasiveness may be further compounded by the fact that although it is typically thought to occur between the 5 and 6 decade of life , it may also strike the paediatric population at virtually any age [ 4 , 7 ] . as such , the aforementioned two cases serve to contrast the possible circumstances in which the tumour may occur . the second instance also highlights the first possible reported occurrence of a synchronous presentation of a splenic angiosarcoma alongside a colonic adenocarcinoma , further emphasizing the fact that the former may carry with it a neoplastic risk which extends well beyond distant metastasis .