Hepatocellular Carcinoma with Sarcomatoid Change without Anticancer Therapies

Abstract

Hepatocellular carcinoma (HCC) with sarcomatoid change is a rare neoplasm of the liver, and recurrent therapies for HCC such as transcatheter arterial chemoembolization and percutaneous ablation therapy are presumed to promote sarcomatoid change. A 73-year-old man was admitted to our hospital diagnosed as having liver cancer originating from hepatitis C-related cirrhosis without any previous treatment for HCC. Ultrasonography showed that the tumor was hypoechoic, 3 cm in diameter, with unclear margins. Computed tomography demonstrated a low-density lesion with ring enhancement on delayed phase. Under a diagnosis of poorly differentiated HCC the patient underwent liver resection. Histologically, the tumor consisted of proliferation of spindle-shaped sarcomatoid carcinoma cells with unclear trabecular and pseudoglandular structures including a nodule of typical moderately differentiated HCC, which was observed to shift mutually in one region. Here, we report a case of sarcomatoid HCC with a review of the literature.

Clinical Manifestations and Outcomes of Patients with Sarcomatoid Hepatocellular Carcinoma

“…In another study that included 28 patients with sarcomatoid HCC, 19 patients (67.9%) had chronic hepatitis B and none had chronic hepatitis C. (23) The CT findings of sarcomatoid HCC have shown irregularly demarcated intrahepatic masses with delayed prolonged peripheral enhancement caused by rapid growth with central necrosis and hemorrhage as well as peripheral viable cancerous tissue. (24) In our study, the CT findings of approximately half of the patients showed hypodense or heterogeneous masses with a peripherally enhanced rim, central necrosis, and hemorrhage in the arterial phase. The tumor capsule was occasionally observed in some cases.…”

Clinical features of sarcomatoid change in patients with intrahepatic cholangiocarcinoma and prognosis after surgical liver resection: A Propensity Score Matching analysis

“…The true mechanism remains unknown. With the increase in reports of iCCA‐SC without previous anticancer therapy, sarcomatoid change has been increasingly considered to be due to the natural progression of cholangiocarcinoma, genetic expression alterations or stochastic phenotype switching . Seol et al determine the expression of genes related to cholangiocarcinoma sarcomatous transdifferentiation using DNA microarray technology.…”

Sarcomatoid Hepatocellular Carcinoma with Spontaneous Intraperitoneal Bleeding

“…Among 10 patients with ruptured HCC who underwent CEUS with Levovist and abdominal angiography, Matsumoto et al (9) found that CEUS was successfully used to differentiate active from inactive hemorrhage by detecting the contrast agent in ascites. In addition, Sugihara et al (10) found that CEUS with Sonazoid is effective for identifying bleeding sites on the hepatic surface after RFA based on the presence of jet-like high-intensity echoes in pleural effusion, although the findings could not be confirmed on color Doppler imaging.…”