Intrahepatic cholangiocarcinoma with extensive sarcomatous change: Report of a case

Abstract

A 77-year-old woman was admitted to our hospital with severe upper abdominal pain. Ultrasonography showed a well-defined hypoechoic mass with heterogeneity in the left lobe of the liver, and computed tomography demonstrated a low-density mass with enhanced peripheral areas. Magnetic resonance imaging revealed a mass with iso- to low signal intensity on T1-weighted images (WI) and heterogeneous high and low signal intensity on T2 WI. The tumor was found to be hypovascular by angiography. During 5 months of observation, the tumor increased in size, which strongly suggested malignancy. A laparotomy was performed under the provisional diagnosis of a neoplasm other than hepatocellular carcinoma, revealing that the hepatic mass had invaded the gastric wall. Therefore, a left hepatic lobectomy with dissection of the lymph nodes and hemigastrectomy was carried out. Histologically, the tumor was found to be composed of a large amount of sarcomatous elements and a small amount of adenocarcinomatous elements, both of which were partly intermingled. Immunohistochemically, the sarcomatous element demonstrated the features of malignant fibrous histiocytoma (MFH). Thus, a diagnosis of intrahepatic cholangiocarcinoma with MFH-like sarcomatous change was confirmed.

Analysis of intrahepatic sarcomatoid cholangiocarcinoma: Experience from 11 cases within 17 years

“…CT scan showed heterogeneous, lobulated hypodense hepatic masses with irregular rim or peripheral enhancement. These are similar to those reported in previous studies[3,24-26]. The imaging findings of 11 patients tended to show relatively aggressive features, which included large mass size (mean: 7.3 ± 2.2 cm, median: 7.5 cm), frequent LN and distant metastases, and extensive metastatic lymphadenopathy accompanied by invasion of portal vein or hepatic parenchyma ( n = 2).…”

CT and MRI findings of sarcomatoid cholangiocarcinoma

“…In our case, the tumour appeared as a heterogeneous hypoechoic mass on ultrasonography. The common view in the literature was a hypodense tumour on CT images [ 5–7 ] . In a few previously reported cases, the tumour showed hypointensity relative to liver parenchyma on T1-weighted images and hyperintensity relative to liver parenchyma on T2-weighted images [ 4 , 7 , 9 ] .…”

Intra‐abdominal spindle cell lesions: a review and practical aids to diagnosis

“…Sarcomatoid carcinoma in the stomach is very rare and has a predilection for the pylorus; the carcinomatous component is usually adenocarcinoma of varying degrees of differentiation 125 , 127 . Sarcomatoid carcinoma has also been described in the small intestine, 128 colon, 129 anus, 130 liver 131 , 132 and gall bladder 133 . In the pancreas, sarcomatoid carcinoma is well recognized with 4 distinct histological subtypes: spindle cell carcinoma, pleomorphic giant cell carcinoma, round cell anaplastic carcinoma and malignant giant cell tumour 134 , 135 …”