A rare histologic subtype of hepatocellular carcinoma, sarcomatoid hepatocellular carcinoma: report of a case

Abstract

Worldwide, primary liver cancer is the fourth leading cause of cancer mortality. Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Sarcomatoid hepatocellular carcinoma (SHC) is a rare subtype of HCC with conventional HCC admixed with areas with sarcomatoid morphology. SHC is an aggressive, rapidly growing tumor with unfavorable prognosis. Pedunculated SHC is an uncommon presentation of SHC. Due to its rarity, much remains unknown about the etiopathogenesis, molecular underpinnings, and treatment of SHC. We present a case of an exophytic SHC arising in a background of cirrhosis in an older adult. A resection was performed, but the patient subsequently developed multiple additional intrahepatic metastatic lesions necessitating further treatment with chemotherapy.

Sarcomatoid hepatocellular carcinoma in a young African female

“… 14 SHC must be differentiated from combined tumors with separate primary foci of HCC and sarcoma, as the absence of mixing of different tumors on histopathology and immunohistochemistry in the different tumors is diagnostic. 11 This study was unable to demonstrate the positivity of either cytokeratin or vimentin in epithelial or mesenchymal marker of the sarcomatoid lesions. However, there have been cases whereby only a third of the cases demonstrate both cytokeratin and vimentin positivity.…”

“…8 Compared with conventional HCC, patients with SHC tend to have poorly differentiated large tumor size, frequent tumor necrosis, advanced stage, higher grade at presentation, and higher rates of lymph node metastases. 5,11 The CT imaging typically shows peripheral ring enhancement and no enhancement in the center. The delayed and prolonged peripheral enhancement correlates with extensive interstitial space, allowing slow diffusion of contrast between interstitial and vascular spaces.…”

Disease Control Achieved Using Atezolizumab + Bevacizumab in a Patient With Sarcomatoid Hepatocellular Carcinoma (SHCC), a Rare Variant Excluded From the IMbrave150 Trial

“… 1 For nonsurgical candidates, treatment options include bland or percutaneous ethanol ablation, radiofrequency ablation, chemoembolization, radioembolization, external beam radiation, hormonal therapy, immunotherapy, thermotherapy, and systemic therapy. 2 , 9 , 17 , 21 Although early surgical resection is associated with a reduced risk of death in SHCC patients, surgical intervention is often not feasible due to advanced stage at diagnosis. 2 In addition, whereas resection offers the only chance of cure, OS is still poor, with no patients with stage 2, stage 3, or stage 4 disease surviving longer than 2 years.…”

“…The differential diagnosis for spindle cell tumors is extensive and includes metastatic sarcomas, 8 primary hepatic sarcoma, hepatic carcinosarcomas (CS), and collision tumors. 9 The terms CS and SHCC are sometimes used interchangeably by some, whereas others refer to the former only for heterogeneous tumors with elements, such as leiomyosarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, or osteosarcoma. 10 The World Health Organization (WHO) defines SHCC as consisting of spindle cells or large giant cells 11 that are mixed with sarcomatous 10 and carcinomatous components, such as HCC or cholangiocarcinoma.…”

“…10 Immunohistochemical markers provide a reliable distinction between the 2 variants. 9,10 Distinction relies on the expression of epithelial markers such as keratin 6,9 that is retained in the spindle cells of SHCC, whereas CS tumors lack these epithelial markers and are considered truly heterogeneous. 10 Sarcomatous components in SHCC tumors stain positive for vimentin.…”