Sarcomatous intrahepatic cholangiocarcinoma

Abstract

Rationale:Sarcomatous intrahepatic cholangiocarcinoma is a rare histological variant of cholangiocarcinoma (ICC). Previous medical literature has not mentioned the prevalence of this kind of disease, but a poorer prognosis than that of ordinary ICC was indicated. The diagnosis of the sarcomatous ICC is established on histopathological and immunohistochemical examinations. In this article, we present a new case of a patient with sarcomatous ICC who had no radiographic sign of intrahepatic tumor preoperatively.Patient concerns:A 63-year-old man was noted with cholecystolithiasis and right upper abdominal pain. Liver function was within normal limits, although the gamma-glutamyl transpeptidase level was elevated. Serum carbohydrate antigen 19-9 level was elevated. Radiography showed atrophy of the left lobe of the liver, high-intensity signals on T1 weighted images, and low/high-intensity signals on T2 weighted images in hepatic ducts.Diagnoses:The preoperative diagnoses were hepatolithiasis, choledocholithiasis, and cholecystolithiasis.Interventions:Exploratory laparotomy, adhesion release, cholecystectomy, choledocholithotomy, and T tube drainage were performed. During the surgery, an ill-defined tumor was detected on the atrophic left lateral lobe of the liver. Hepatic left lateral lobectomy was performed to remove the mass.Outcomes:The final diagnosis of sarcomatous ICC was made by histopathology after surgery. No evidence of local recurrence or distant metastasis was noted on imaging during follow-up.Lessons:Although rare, sarcomatous ICC does exist in patients presented with cholecystolithiasis and liver atrophy. Surgeons should be aware of the existence of sarcomatous ICC due to the poor prognosis. We recommend that multidisciplinary approaches may be key to improve prognosis, including adjuvant chemotherapy or radiotherapy.

Sarcomatoid intrahepatic cholangiocarcinoma in a patient with poor prognosis: a case report and literature review

“…In published case reports, the median survival of patients with S-iCCA who underwent surgical resection was 11 months, which is comparable with that in patients with ordinary iCCA who did not undergo surgery (8 months). 4 The median survival of patients with S-iCCA who did AST: aspartate aminotransferase; ALT: alanine aminotransferase; GGT: gamma-glutamyl transferase; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; N/A: not available. not undergo surgery was 3 months, which is considerably shorter than that of patients with ordinary iCCA.…”

“…It has been reported that sarcomatoid hepatocellular carcinoma (HCC) may be associated with preoperative anticancer treatments, such as transcatheter arterial chemoembolization, radiofrequency ablation, or percutaneous ethanol injection. [4][5][6] However, there is no relevant study demonstrating the association between anticancer treatments and S-iCCA. Confirmation by biopsy and immunohistochemical staining is critical to establish a definitive diagnosis of S-iCCA.…”

Sarcomatous carcinoma in biliary system

“…In conclusion, sarcomatous biliary carcinoma, including SIC and SCC, is very rare and malignant, which is diagnosed by postoperative histopathologic examinations. The prognoses of SIC and SCC were worse than that of ICC [22] and choledochal carcinoma. The pathologic diagnosis of metastasis of lymph nodes, and level of Ki-67 index of the tumor were possible indicators for postoperative survival.…”

Intrahepatic Carcinosarcoma With Cholangiocarcinoma Elements and Prominent Bile Duct Spread

“…[3][4][5] However, nearly all intrahepatic cholangiocarcinomas with spindle cell components are sarcomatous intrahepatic cholangiocarcinomas. [6][7][8][9] Accordingly, only a few reports have described carcinosarcomas, [10][11][12][13][14][15] and the characteristic spreading pattern and radiological findings of intrahepatic carcinosarcomas with cholangiocellular differentiation remain unclear.…”