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

Abstract

Purpose: To improve the understanding of hepatic carcinosarcoma (HCS) by analyzing radiological imaging data and clinicopathological features. Materials and Methods: A retrospective analysis was performed on four patients with HCS confirmed immunohistochemically. The analysis included three males and one female, aged 29 to 64 years. Four patients underwent computed tomography (CT) scans, and one underwent magnetic resonance imaging (MRI) scans simultaneously. Results: Three patients had a history of hepatitis B, cirrhosis or fibrosis, and two patients had schistosomiasis. Two cases tested positive for elevated serum carbohydrate antigen (CA) 19-9. The maximum diameters of the lesions ranged from 7.8 to 9.0cm. Pathologically, the carcinomatous and sarcomatous elements in two patients could not be classified, one of the patients had cholangiocellular carcinoma (CCC) and undifferentiated sarcoma, the other had hepatocellular carcinoma (HCC) and undifferentiated pleomorphic sarcoma (UPS). All tumors showed heterogeneous density/intensity, accompanied by vast cystic changes and necrosis, with two cases having cystic septations. Capsule formation was not identified. The margins of the radiological images showed irregular ring enhancement. One case presented continuous progressive enhancement, one case with "fast in fast washout" and two cases with "fast in late washout". Lymphonodus metastasis, satellite nodules, vascular embolism, and organ invasion (hepatic flexure of the colon) were identified. Conclusion: HCS is a rare, high-grade malignancy with poor prognosis. The preoperative diagnosis is expected to improve by carefully analyzing the imaging features of the patients in combination with their clinical characteristics. Radical resection and postoperative chemoradiotherapy can improve the survival rate of patients.

Primary Liver Sarcomatoid Carcinoma: A Case Series and Literature Review

“…PLSC is reported to be more common in older males, who account for 73-82.5% of cases. [8][9][10] In the 136 pooled cases, 72.8% of PLSC cases were male, but there were minor differences between old and young aged cases with a ratio of 0.90. Hepatitis is considered as a possible risk factor, 10 but not drinking, the anti-tumor treatment history, or gallbladder stones.…”

“…However, clinical misdiagnosis of PLSC is possible due to atypical symptoms and serological and radiological results. 9,10,[30][31][32] Leukemoid reaction has also been reported as the earliest manifestation, which makes the diagnosis more confusing. 33,34 Satellite nodules with similar radiological features as the main lesion may also be a clue to the presence of PLSC.…”

“… 15 , 16 Another notable observation has been that PLSC is prevalent in Asian countries, especially in China, the Republic of Korea, and Japan, 17 but there are less cases infected with hepatitis in Japan. A 29-year-old PLSC patient has been reported with a 10-year history of schistosomiasis, who was negative for hepatitis B and C. 9 Besides PLSC, schistosomiasis infection was also reported in bladder sarcomatoid carcinoma. 18 , 19 Thus, schistosomiasis cannot be ruled out as a risk factor.…”

Rare primary hepatic carcinosarcoma composed of hepatocellular carcinoma, cholangiocarcinoma, and sarcoma: a case report

“…Therefore, HCS is always reported to present as heterogeneous low-attenuation lesions with large necrotic cystic portions on plain CT scan, T1-weighted hypointense, T2-weighted hyperintense, and irregular peripheral reinforced masses on enhanced imaging. 5,6 Liu et al. reported the typical contrast-enhanced sonography findings of HCS, which were similar to enhanced-CT imaging.…”

“…HCS is more common in middle-aged and elderly male patients, most of whom have a history of chronic hepatitis. 5 This shows that the development of HCS may be related to liver cirrhosis as well as hepatitis B virus infection. HCS tumors are usually relatively large when symptoms appear, presenting with nonspecific gastrointestinal symptoms, such as abdominal pain, abdominal distension, and dyspepsia.…”