Combined hepatocellular and cholangiocarcinoma with sarcomatoid transformation: radiologic–pathologic correlation of a case

Abstract

A 71-year-old man presented to our hospital with 3-week history of fever in the background of loss of both weight and appetite over the past 3 months. He was found to have a large 10-cm mass in the right lobe of the liver on a triple-phase computed tomographic scan. The tumor showed a distinct fatty component, with areas of arterial enhancement and venous washout suggestive of hepatocellular carcinoma (HCC), another component showing progressive and late enhancement suggestive of cholangiocarcinoma (CC), and a third component showing persistent hypoenhancement relative to the liver parenchyma. He underwent surgical resection. This was histopathologically a biphasic tumor composed of areas showing hepatocytic differentiation, in contiguity with areas showing infiltrative glands set within fibrous stroma in keeping with combined hepatocellular and cholangiocarcinoma (cHCC-CC). A third component of pleomorphic spindle and epithelioid appearance in keeping with sarcomatous transformation was also found intimately related to the CC component. The patient developed extensive thoracic and abdominal metastases 2 months after surgery and died shortly after.

Clinical and imaging characteristics of primary hepatic sarcomatoid carcinoma and sarcoma: a comparative study

“…Unlike previous reports that patients with PHSs had no evidence of hepatitis or cirrhosis (4,18), ten (62.5%) of sixteen PHSs in our study were positive for hepatitis or cirrhosis, which might be related to our infectious disease hospital where most people come with infectious disease such as viral hepatitis. Fourteen (73.7%) of 19 PHSCs had the background of liver cirrhosis, similar to previous reports that hepatitis virus infection might have relationship with the occurrence of PHSCs (5,19). For PHSs, most of the laboratory data were negative (11,15), but nearly half of the PHSC patients were positive for AFP, which might be helpful in its diagnosis.…”

“…The PHSC and PHS have many overlapping features in imaging as well as clinical and pathological ndings (4)(5)(6), but their treatment modalities may be different, even though the most optimal therapy still awaits further evidence, due to the dearth of available information caused by their rarity. In the group of PHSs, recent studies have suggested that a combination of surgery and pre-or post-surgical chemotherapy can substantially improve clinical outcomes of the UES.…”

Primary liver carcinoma with sarcomatous changes: Analysis of 10 cases

“…However, this pattern of enhancement on enhanced CT is not specific for SC and can represent metastases or liver abscesses. Thus, SC induce loss of the classic imaging features of PLC . In terms of prognostic factors, tumor size was the only independent preoperative factor.…”

“…Thus, SC induce loss of the classic imaging features of PLC. 17,18 In terms of prognostic factors, tumor size was the only independent preoperative factor. Accordingly, surgical resection should be undertaken in patients with small tumor and the above imaging features, whereas RFA and/or PEIT should be avoided.…”

Combined sarcomatoid hepatocellular and cholangiocarcinoma: a case report and literature review

“…Age, gender Symptoms Hepatitis serology Treatment Follow-up and prognosis Nakajima et al [4] 74 years, male Right upper quadrant pain HBsAb TACE Lung metastasis; death at 17 months; diagnosis at autopsy Papotti et al [5] 59 years, male Lumbar pain Negative Hepatectomy Biliary fi stula; death at 4 months Jeong et al [6] 60 years, female Right upper quadrant pain/mass NA Hepatectomy Tumor recurrence; death at 12 months Kim et al [7] 67 years, male Synchronous colon tumor NA NA NA Boonsakan et al [8] 28 years, male Fever HBsAg Palliative resection Lost to follow-up Pua et al [9] 71 years, male Fever, weight loss, anorexia Negative Hepatectomy Lung and pleural metastasis; death at 6 weeks NA: not available; HBsAb: hepatitis B surface antibody; HBsAg: hepatitis B surface antigen; TACE: trans-arterial chemoembolization…”