Hepatocellular carcinoma with sarcomatous change: characteristic findings of two-phased incremental CT

Honda, Hiroshi; Hayashi, Takamoto; Yoshida, Kou; Takenaka, Katsuto; Kaneko, Koichiro; Fukuya, Tatsuro; Tateshi, Y.; Ro, T. K.; Maeda, Takashi; Masuda, Kouji

doi:10.1007/s002619900006

Cited by 43 publications

(37 citation statements)

References 19 publications

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“…These results agree with those from previous studies in which peritumoral parenchymal enhancement or tumorous arterioportal shunt was associated with microvascular invasion (16,17,34). The rim enhancement pattern has been also suggested to indicate rapid progression, poor differentiation, and worse prognosis (22,25,35), possibly by reflecting the absence of a capsule, infiltrative growth, and the presence of microvascular invasion as well as rapid growth with central necrosis.…”

Section: Discussionsupporting

confidence: 83%

Single Hepatocellular Carcinoma: Preoperative MR Imaging to Predict Early Recurrence after Curative Resection

An¹,

Kim

Park³

et al. 2015

Radiology

181

130

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Purpose:To identify magnetic resonance (MR) imaging features that enable prediction of early recurrence (,2 years) after curative resection of hepatocellular carcinoma (HCC) and to derive a preoperative prediction model. Materials and Methods:This retrospective study was approved by the institutional review board. The requirement to obtain written informed consent was waived. A total of 268 patients who underwent hepatic resection for a single HCC from January 2008 to August 2011 were divided into two cohorts: a training cohort, which was used to derive a prediction model (n = 187), and a validation cohort (n = 81). All MR images from the training cohort were reviewed by two radiologists. A prediction model was constructed by using MR imaging features that were independently associated with early recurrence with use of multiple logistic regression analysis. The performance of the prediction model in the validation cohort was evaluated with respect to discrimination (ie, whether the relative ranking of individual predictions of subsequent early recurrence is in the correct order). Results:In the training cohort, four MR imaging features were independently associated with early recurrence: rim enhancement (odds ratio [ Conclusion:The prediction model derived from rim enhancement, peritumoral parenchymal enhancement, satellite nodule, and tumor size can be used preoperatively to estimate the risk of early recurrence after resection of a single HCC.q RSNA, 2015

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Section: Discussionsupporting

confidence: 83%

Single Hepatocellular Carcinoma: Preoperative MR Imaging to Predict Early Recurrence after Curative Resection

An¹,

Kim

Park³

et al. 2015

Radiology

181

130

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“…Sarcomatous HCC is an aggressive variant of HCC with an incidence of 3.9-9.4%, with either a sarcomatous change in part of the HCC or coexistence of a sarcoma and HCC [13]. Histologically, sarcomatoid HCC consists of very poorly differentiated cells that grow rapidly, resulting in central necrosis or hemorrhage due to inadequate blood supply.…”

Section: Sarcomatoid Hccmentioning

confidence: 99%

“…No capsule, intratumoral fat, or central scar is present. On cross-sectional images, sarcomatoid HCC shows peripheral enhancement with an unenhanced central portion that correlates to viable cancerous tissue with fibrous stroma in the periphery and central necrosis of the tumor, respectively [13] (Fig. 3).…”

Section: Sarcomatoid Hccmentioning

confidence: 99%

Hepatocellular Carcinoma Variants: Radiologic-Pathologic Correlation

Chung

Park

et al. 2009

American Journal of Roentgenology

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W7poorer prognosis than classic HCC, whereas fibrolamellar HCC shows better prognosis and sclerosing HCC shows prognosis similar to classic HCC [5][6][7]. Radiologically, these variants do not share imaging characteristics typical of HCC.The diagnosis of HCC larger than 2 cm can be made without biopsy if a mass in a cirrhotic liver shows the typical features of HCC on contrast-enhanced CT or MRI and the α-fetoprotein level is greater than 200 ng/mL [8]. In the case of HCC with atypical imaging features, however, this guideline cannot be applied. Therefore, recognizing these variants and their imaging features has clinical consequences, even though a preoperative biopsy is still needed because these variants cannot be completely differentiated from other tumors by imaging only.In this article, we collectively review and illustrate the radiologic findings for variant types of HCC and correlate these findings with pathologic analyses. HCC, Predominantly Clear Cell TypeCytoplasmic fat is frequently present in well-differentiated HCC and is abundant in approximately 10% of cases. A large amount of cytoplasmic fat or glycogen can cause the cytoplasm to appear white in routine pathologic sections, producing a "clear cell" appearance. On microscopy, 19.6% of HCCs have been reported to have cytoplasmic fat. On imaging, however, only 1.6% of cases have been reported to show a cytoplasmic fat component [9]. HCCs with a clear cell appearance frequently show increased echogenicity on sonography and decreased attenuation on is the most common form of primary hepatic tumor and its incidence has increased in recent years. The risk factors for HCC are well established and include viral hepatitis, alcoholic liver cirrhosis, and exposure to hepatotoxins. The typical sonographic and unenhanced CT findings of HCC show a well-circumscribed hypoechoic or hypoattenuated mass with or without the hypoechoic rim of a tumor capsule. MRI typically shows that HCC is hyperintense relative to the liver on T2-weighted images and hypointense on T1-weighted images. On dynamic CT and MRI, HCC shows early enhancement in the arterial phase and contrast medium washout in the equilibrium phase. Equilibrium phase CT and MRI could show a thin rim-enhancing tumor capsule with variable incidence, ranging from 10% to 80.7% of the cases, depending on the series [1]. G a s t r oi nt e s t i n a l I m ag i ng • Pic t o r i a l E s s ayAlthough the prevalence is variable depending on the series, hemorrhage or calcification (~ 5%), central scar (~ 3%), or gross fat (~ 1.6%) may be seen within the HCC tumor [2]. HCC in noncirrhotic patients usually manifests as either a large solitary mass or a dominant mass with small satellite nodules that more frequently shows necrosis and central scar formation than HCC in cirrhotic patients [3].

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“…In the present case, the sarcomatoid changes were speculated to be induced by anti-HCC treatment, including radiofrequency ablation (RFA), percutaneous ethanol injection and transarterial chemoembolization, resulting in the degeneration, necrosis and regeneration of tumor cells (7,8). However, previous studies have reported cases with no history of prior therapy (8,9). The CT findings of sarcomatoid HCC have been reported to include irregularly demarcated intrahepatic masses with delayed prolonged peripheral enhancement (10).…”

Section: A B C Dmentioning

confidence: 70%

Sarcomatoid Hepatocellular Carcinoma with Spontaneous Intraperitoneal Bleeding

et al. 2015

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An 80-year-old woman was admitted to our hospital with right hypochondralgia. Abdominal ultrasonography showed a well-circumscribed round lesion in segments 5 and 6 of the liver. Contrast-enhanced ultrasonography (CEUS) indicated that the tumor was enhanced in the arterial phase, changing to hypo-enhanced 30 seconds following contrast injection. After admission, the patient complained of epigastralgia, and CEUS subsequently demonstrated extravasation from the tumor. Although abdominal angiography was successful for achieving hemostasis, the tumor grew rapidly and the patient died. An autopsy revealed the presence of sarcomatoid hepatocellular carcinoma (HCC). The literature is lacking in details regarding CEUS findings for sarcomatoid HCC and rupture. We herein report a rare case of sarcomatoid HCC.

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Hepatocellular carcinoma with sarcomatous change: characteristic findings of two-phased incremental CT

Abstract: The appearance of HCCSC on CT is that of an irregularly demarcated intrahepatic mass with delayed or prolonged peripheral enhancement, frequently with intrahepatic metastases and lymphadenopathy.

Cited by 43 publications

References 19 publications

Single Hepatocellular Carcinoma: Preoperative MR Imaging to Predict Early Recurrence after Curative Resection

Single Hepatocellular Carcinoma: Preoperative MR Imaging to Predict Early Recurrence after Curative Resection

Hepatocellular Carcinoma Variants: Radiologic-Pathologic Correlation

Sarcomatoid Hepatocellular Carcinoma with Spontaneous Intraperitoneal Bleeding

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