Unusual Liver Carcinomas with Sarcomatous Features: Analysis of Four Cases

Abstract

We recently examined the clinicopathological and immunohistochemical features of four cases of primary hepatic carcinoma with sarcomatoid elements. Three of the four patients had associated ordinary hepatocellular carcinoma (HCC) and one had a sarcomatoid carcinoma with no apparent elements of HCC. The presenting symptoms were high fever and hypochondralgia in three patients, and right hypochondralgia without a high fever in one. The preoperative diagnoses were liver abscess in two patients, HCC in one, and cholangioma in one. Preoperative imaging showed necrotic change or abscess formation in the tumors. The sarcomatous elements showed a positive reaction to vimentin in three patients, but the ordinary HCC cells did not. Macroscopically, the tumors appeared as a single nodule with pericapsular growth. The prognoses of these patients were poor due to the early development of intrahepatic or distal metastases. We conclude that symptoms such as a high fever or hypochondralgia are characteristics of these tumors and that they may be histogenetically derived from a dedifferentiation of HCC, although no elements of HCC were found in one of our cases.

Hepatocellular Carcinoma with Sarcomatoid Change without Anticancer Therapies

“…In addition, the immunohistochemical study for cytokeratin, epithelial membrane antigen, hepatocyte and vimentin is helpful in the pathological diagnosis [6]. Generally, components of sarcomatoid lesions are positive for both cytokeratin (epithelial marker) and vimentin (mesenchymal marker) [1, 2, 10]. The tumor in the present case was diffusely positive for vimentin and cytokeratin 7, and focally positive for hepatocytes, which is consistent with sarcomatoid HCC.…”

“…When compared with typical HCC, the prognosis of sarcomatoid HCC was unfavorable due to widespread metastasis [1, 4, 9, 10]. Hwang et al [11] reported that the 3-year survival rates for sarcomatoid HCC after liver resection and liver transplantation were 18.2 and 37.5%, respectively.…”

Prognostic Significance of Sarcomatous Change in Patients with Hepatocellular Carcinoma After Surgical Resection

“…Similar to the findings in previous studies, adjacent organ invasion and lymph node metastasis were relatively less frequent in ordinary HCC than in HCC with SC. 3,15,16 We felt this highly invasive behavior might be attributed to the sarcomatous component in HCC with SC. Since HCC with SC was highly aggressive, it had a higher tendency for advanced stage tumor than ordinary HCC, and was thus the reason why TNM staging was different between the two groups.…”

“…In addition, SC in HCC patients who had not previously undergone anticancer therapy has been also reported. 3,9,10 Clinically, the presence of SC in HCC is thought to be associated with more aggressive tumor biology, higher rates of recurrence, more frequent metastasis, and poorer survival. [5][6][7] Even in patients with curative resection, the possibility of local recurrence or distant metastasis is extremely high.…”

“…Among these histological varieties, the coexistence of sarcomatous change (SC) and HCC has been reported sporadically. [1][2][3][4][5] When the tumor is simply composed of sarcomatous cells, it is difficult to differentiate from true sarcomas such as myosarcoma. If sarcomatous features are principal, the tumor is known as sarcomatoid HCC.…”