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/㎖. With the clinical impression of hepatocellular carcinoma, CT
(computerised tomography) angiography and hepatic angiography were performed
and demonstrated a 5 ㎝ 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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