Hepatic angiosarcoma with elevated alpha-fetoprotein: a diagnostic challenge.

<title>Abstract</title> The elevation of alpha-fetoprotein is typically associated with hepatocellular carcinoma, hepatoblastoma, and germ cell tumors, but we can also find high levels of alpha-fetoprotein in vascular mesenchymal tumors such as hepatic angiosarcoma. We present the case of a 74-year-old patient who initially presented with Budd-Chiari syndrome and a significant elevation of alpha-fetoprotein, with a high level of suspicion of hepatocellular carcinoma. However, hepatocellular carcinoma was reasonably ruled out after complementary tests were performed. The patient’s clinical and analytical progression pointed towards the presence of a hepatic angiosarcoma, which can be associated with elevated alpha-fetoprotein levels and may represent a diagnostic challenge if there is not a high level of suspicion.