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J Korean Surg Soc. 2002 Mar;62(3):262-265. Korean. Case Report.
Kim JH , Yoo YB , Yu HC , Lee DY , Moon WS , Cho BH .
Department of Surgery, Chonbuk National University Medical School, Chonbuk, Korea.
Department of Pathology, Chonbuk National University Medical School, Chonbuk, Korea.
Institute for Medical Science, Chonbuk National University Medical School, Chonbuk, Korea.
Department of Surgery, College of Medicine, Konkuk University, Seoul, Korea.

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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