Primary Fibrosarcoma of the Liver: We Don’t Know Much

Abstract

A 60-year-old lady presented to us with a right upper abdominal mass. With a clinical diagnosis of liver tumor, she was evaluated with abdominal CT, MRI, nuclear scan, tumor markers, USG guided FNAC and other baseline investigations. On evaluation she had a massive right lobe tumor crossing the midline. In view of the ambiguous diagnosis she was subjected to laparotomy where the lesion was judged unresectable and a biopsy was taken. Histopathological examination showed the rare pathology of primary fibrosarcoma of the liver with features of homogeneous, spindle-shaped cells with abundant collagen fibers showing a classic herringbone pattern. Tissue samples were then sent to another referral cancer hospital for immunohistochemistry and immunoreactive vimentin was found in the tumor cells. Electron microscopically, the tumor cells were rich in rough endoplasmic reticulum without a basement membrane, and were surrounded by large amounts of collagen fibers. The fibroblastic character of the tumor cells was suggested by light and electron microscopy.

Fibroblastoid and Myofibroblastoid Tumors of the Liver and Bile Ducts

“…Dubs (1916) reported on a spindle cell sarcoma measuring 30 by 30 by 25 cm diagnosed in a 26-year-old female. Exceptionally, the tumors involve both liver lobes and form conglomerates of firm nodules (Ali et al 2008). The tumor appearance varies from firm and gray to white masses to myxoid lesions and those with hemorrhagic necroses, sometimes with marked central softening (Ito et al 1990).…”

“…In one case of hepatic fibrosarcoma with hypoglycemia, production of insulin-like growth factor II (IGF-II) was proposed to have induced hypoglycemia, based on the detection of IGF-II reactivity in the Golgi area of the neoplastic cells (Kotani et al 1993). Shallow and Wagner 1947;Simpson et al 1955;Steiner 1960;Ojima et al 1964;Snapper et al 1964;Totzke and Hutcheson 1965;Balouet and Destombes 1967;Cavallo et al 1968;Smith and Rele 1972;Walter et al 1972;Chudacek 1973;Alrenga 1975;Papazian et al 1978;Bodker and Boiesen 1981;Gen et al 1983;Kameya et al 1985;Bremondy et al 1989;Nakahama et al 1989;Ito et al 1990;Kotani et al 1993;Tameda and Shiraki 1995;Kelle et al 2005;Ali et al 2008;Zhao et al 2008.…”