Double primary hepatic cancer (sarcomatoid carcinoma and hepatocellular carcinoma): A case report

Abstract

Primary liver sarcomatoid carcinoma (SC) is a rare and aggressive tumor exhibiting rapid growth and a high recurrence rate following resection. To date, there have been no reports of primary liver SC occurring simultaneously with hepatocellular carcinoma (HCC). This is the case report of a 54-year-old man with liver cirrhosis due to hepatitis B virus (HBV) infection and alcoholic hepatitis. The abdominal computed tomography and magnetic resonance imaging revealed two distinct hepatic masses in a background of hepatic cirrhosis and esophageal varices. Following a clinical diagnosis of two HCCs, a right hepatic lobectomy was performed. Grossly, two distinct lesions were identified: the larger mass was gray to white and well-demarcated, sized 2.5×2.0 cm, located in S5-6, whereas the other was a gray to whitish nodule, sized 1.3×1.0 cm, located in S8. The microscopic analysis revealed that the larger mass was a primary liver SC, which was immunoreactive for cytokeratin (CK) and vimentin (VMT) and negative for hepatocyte-specific antigen (HSA). The other nodule was histologically diagnosed as HCC, which was positive for HSA and CK and negative for HSA, VMT, CK7 and CK19. There was no transition or intermingling lesion between the two tumors. To the best of our knowledge, this is the first case report of double primary liver cancer comprising an SC and a HCC.

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

“…Hemorrhage also played a role in the cystic appearance, which was reported more frequently seen in PHSs than some other rare liver malignant tumors and attributed by rupture of the tumor for the serpiginous vessels (10,11). In previous studies, there was often extensive hemorrhage in PHS creating a huge cyst mass so that the underlying tumor was obscured and misdiagnosed as a hematoma, abscess or cystic tumor (28), which also occurred in our study. Although there was no statistical difference in the current study, hemorrhage was more commonly seen in PHSs than PHSCs (50.0% vs 26.1%).…”

“…It has been reported in studies that a cyst-like PHS could be frequently misdiagnosed as a hepatic cyst (4,14,26). However, the presence of feeding vessels, the ndings of hemorrhage and the abrupt increase in its size should alert us to the diagnosis of PHS (11,28).…”

“…The PHSCs were highly aggressive, and the presence of SC were considered to be closely related to the more invasive tumor biology, more common metastasis, low resectability and frequent postoperative recurrences (19,29,30). By contrast, the PHSs usually involved the adjacent anatomic structures, and vascular invasion, metastases and lymph node involvement were less common (9,28).…”

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

“…The capsule invasion [19], vascular invasion or thrombosis, intrahepatic metastasis and lymph node metastasis were more prevalent in PHSCs and in our study the vascular invasion in PHSCs was close to significantly more common than the PHS (P = 0.099). The PHSCs were highly aggressive, and the presence of SC were considered to be closely related to the more invasive tumor biology, more common metastasis, low resectability and frequent postoperative recurrences [19,29,30]. By contrast, the PHSs usually involved the adjacent anatomic structures, and vascular invasion, metastases and lymph node involvement were less common [9,28].…”

Sarcomatoid carcinoma of the common bile duct

“…Sarcomatoid carcinoma, which is characterized by poorly differentiated carcinoma tissue containing a component of sarcoma-like (spindle and/or giant cell) differentiation, is a rare malignant tumor in the gastrointestinal tract and hepatobiliary-pancreatic system. [ 1 ] Sarcomatoid carcinomas have been found at diverse sites including the liver, [ 2 , 3 ] gallbladder, [ 4 – 6 ] pancreas, [ 7 – 9 ] and ampulla of Vater. [ 10 ] Case reports of sarcomatoid carcinoma arising in the common bile duct (CBD) are extremely rare.…”