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

Abstract

Primary hepatic carcinosarcoma (HCS) is an extremely rare malignant tumor of the liver that contains carcinomatous and sarcomatous components. The diagnosis, treatment, and prognosis of HCS pose great challenges to clinicians. Herein, we present a case of HCS in a 67-year-old man with unique pathological manifestation. Preoperative magnetic resonance imaging showed a malignant lesion in the right liver and a small sub-focus in the left liver. Radical treatment was performed, including excision of the right posterior lobe of the liver, thrombectomy of the right posterior portal vein, and radiofrequency ablation of lesions in the left liver. The specimens were confirmed to be HCS by pathological examinations, which revealed a combination of poorly differentiated hepatocellular carcinoma, moderately differentiated cholangiocellular carcinoma, and spindle cell sarcoma. Transhepatic arterial chemotherapy and embolization was performed after surgery. Unfortunately, pulmonary metastasis occurred 1.5 months later, which meant a poor prognosis. In this report, we discuss the clinicopathological characteristics of this case and factors that affected surgical outcomes, which may add some ideas for the future diagnosis and treatment of HCS patients.

Keywords: Liver; carcinosarcoma; case report; diagnosis; magnetic resonance imaging; tumor.

Figure 1.

Computed tomography scans, non-enhanced and enhanced imaging. (a) Plain computed-tomography showed a heterogeneous hypoattenuating lesion in segments 7 and 8 of the liver; contrast-enhanced images showed a peripheral ring-like enhancement mass with reinforced septations. (b) Arterial; (c) portal; and (d) equilibrium phases of imaging.

Figure 2.

Magnetic resonance imaging. (a) T1-weighted images; (b) T2-weighted images. After enhancement, the mass presented as an irregular ring-like enhancement. (c) Arterial phase, a sub-focus located in the lateral segment of the left liver (red arrow) was found. (d) Portal phase; (e) equilibrium phase; (f) embolus in branches of the right posterior portal vein (red arrow).

Figure 3.

Pathological images. (a) Surgically resected specimen showing a multiple nodular-type mass with a central necrotic area. Hematoxylin–eosin (HE) staining (magnification: 100×) (b–c). (b) The poorly differentiated hepatocellular carcinoma (HCC; left), sarcomatous component (middle), and moderately differentiated cholangiocellular carcinoma (CCC; right). (c) There was a clear boundary between spindle and epithelial cells. Immunohistochemical staining (magnification: 40×) (d–g). (d) HepPar-1 was positive in the HCC component; (e–f) CK7 and CK19 were positive in the CCC component; (g) Vimentin was positive in the sarcomatous component.