Carcinosarcoma of the liver: report of a case

Abstract

A 64-year-old Japanese woman without a history of viral hepatitis was admitted for investigation of a huge liver mass. The tumor, measuring 14 × 12 × 22 cm, had invaded the diaphragm, right lung, and inferior vena cava. Serum examinations demonstrated high levels of carbohydrate antigen 19-9 (CA19-9), and the Child-Pugh score was A. She underwent right lobectomy of the liver and partial resection of the right diaphragm, right lung, and inferior vena cava. Radio- and chemotherapy were also given, but she died of recurrence 3 months after surgery. Microscopically, the tumor exhibited intermingled adenocarcinomatous and atypical mesenchymal components. The carcinomatous component was positive for cytokeratins 7, 19, and 20, chromogranin A, epithelial membrane antigen, c-KIT, and vimentin. The sarcomatous component was positive for vimentin and c-KIT. A review of 36 cases of hepatic carcinosarcoma revealed the following: chronic hepatitis or cirrhosis in 57 % of the patients; increased serum CA19-9 levels in 30 %; a mean tumor diameter of 10 cm; invasion of the adjacent organs or metastasis to distant organs in 47 %; wide intrahepatic infiltration in 44 %; and 50 % survival of only 5 months. Significant differences were seen according to tumor diameter (diameter >5 cm; p < 0.05), wide intrahepatic infiltration (p < 0.05), and extrahepatic invasion/metastasis (p < 0.01). Neither chemotherapy nor radiotherapy contributed to prognosis, but surgical resection resulted in some improvement (p < 0.05).

Efficacy and Safety of Nivolumab Plus Apatinib in Advanced Liver Carcinosarcoma: a Case Report

“…Others argue that primary hepatocellular carcinoma transforms into mesenchymal component; the presence of transitional or transformational zones between carcinoma and sarcoma in some cases supports this view [7][8][9]. According to the study by Yamamoto et al, which analyzed the reports published before 2003, more than half of the liver carcinosarcoma patients had a medical history of chronic viral hepatitis or cirrhosis [2,4], which supports that the opinion of the latter. Although there have been many studies of predictive and prognostic biomarkers in liver cancer (including primary liver cancer and metastatic liver cancer) [10], there are still no prognostic biomarkers studied in liver carcinosarcoma.…”

“…Even among those patients who can receive surgery resection, most die within 1 year due to the recurrence. The median survival time of patients with metastatic diseases is only about 6 months [4]. Conducting clinical studies in liver carcinosarcoma is very difficult due to the low incidence of this malignancy, and the treatment experiences of such patients from case reports or case series are very important in choosing regimen for patients with advanced diseases.…”

<p>The Clinicopathological and Imaging Characteristics of Primary Hepatic Carcinosarcoma and a Review of the Literature</p>

“…In the retrospective literature, 24 articles 2,3,[7][8][9][10][11]13,14,17,[19][20][21][22][23][24][26][27][28][29][30][31][32][33] were involved in the imaging manifestations, including our study of total of 35 patients. Due to the different proportion of carcinomatous components and sarcomatous components in HCS, and their pathological types were not the same, the imaging manifestations were different.…”

“… 2 – 35 Among them, there were 24 related to image representation. 2 , 3 , 7 – 11 , 13 , 14 , 17 , 19 – 24 , 26 – 33 …”

Primary carcinosarcoma of the liver: imaging features and clinical findings in six cases and a review of the literature

“…Although radical resection is still recommended [ 2 ], the presence of extrahepatic metastases, vessel involvement, and/or invasion of surrounding organs renders curative resection impossible. Careful follow-up and postoperative intervention, including radiotherapy and chemotherapy, might be beneficial for extending disease-free survival [ 4 , 7 , 11 , 18 ].…”