J Korean Surg Soc.
2002 Mar;62(3):262-265.
Sarcomatoid Hepatocelluar Carcinoma
- Affiliations
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- 1Department of Surgery, Chonbuk National University Medical School, Chonbuk, Korea. hcyu@moak.chonbuk.ac.kr
- 2Department of Pathology, Chonbuk National University Medical School, Chonbuk, Korea.
- 3Institute for Medical Science, Chonbuk National University Medical School, Chonbuk, Korea.
- 4Department of Surgery, College of Medicine, Konkuk University, Seoul, Korea.
Abstract
- We recently experienced a case of sarcomatoid hepatocellular carcinoma. A 56 years old male was admitted complaining of several days of epigastric pain. Upon admission, the patient demonstrated a positive HCV Ab, and negative HBs Ag. Relevant laboratory findings included; AST 39 IU/L, ALT 29 IU/L, alpha-fetoprotein (AFP) 3.2 ng/ml, and carcinoembryonic antigen (CEA) 4.5 ng/ml. With the clinical impression of hepatocellular carcinoma, CT (computerised tomography) angiography and hepatic angiography were performed and demonstrated a 5 cm sized round mass, with mild heterogenous enhancement on CT hepatic arteriography (CTHA) and a defect on CT arterial portography (CTAP) along with intense tumor staining on hepatic arteriography in the lateral segment of the left lobe. A segmental resection (S3 region) was done. The intraoperative findings revealed a bulging tumor with gall bladder and peritoneal invasion. Microscopically, the tumor was composed of pleomorphic spindle cells with prominent nucleoli and frequent mitosis, and it showed a sinusoidal infiltrative growth pattern at the tumor-non tumor boundary. The tumor cells reacted positively with cytokeratin, vimentin, fibrinogen and epithelial membrane antigen (EMA) and reacted negatively with cytokeratin19, cytokeratin7, cytokeratin20, CEA, AFP and CD34. The spindle-shaped tumor cells were considered to be sarcomatoid hepatocellular carcinoma with a malignant fibrous histiocytoma-like area.
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