Double primary hepatic cancer (sarcomatoid carcinoma and hepatocellular carcinoma): A case report

A retrospective study on the clinical and pathological features of hepatic sarcomatoid carcinoma: Fourteen cases of a rare tumor

Hepatic sarcomatoid carcinoma is a rare liver malignancy with atypical clinical symptoms and a high degree of malignancy. To improve the understanding of this disease, we collected the clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma admitted to the First Affiliated Hospital and Second Affiliated Hospital of Bengbu Medical College from 2011 to 2021 and reviewed the relevant literature. The clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma were collected from the electronic medical record system of the 2 hospitals. All clinical data were independently reviewed by 2 clinicians, and all pathological data were independently reviewed by 2 pathologists. At the same time, we reviewed the related literature on hepatic sarcomatoid carcinoma in Pubmed and CNKI. This group of 14 patients, 10 males and 4 females, aged 50-77 years. The main symptoms of the patients were abdominal pain, bloating, anorexia, fatigue or weight loss in the upper abdomen, and 3 patients were asymptomatic. On imaging, hepatic sarcomatoid carcinoma manifests as heterogeneous mass with irregular shape and unclear boundary, and computed tomography (CT)/magnetic resonance imaging (MRI) enhanced scan shows progressive or persistent heterogeneous enhancement, marginal enhancement or annular enhancement, and central necrosis. The pathological features of hepatic sarcomatoid carcinoma are the proliferation of spindle cells and pleomorphic cells, which alternate with acinar cells. Hepatic sarcomatoid carcinoma is more common in middle-aged and elderly patients, especially men, and has no characteristic clinical manifestations. Imaging examination and B-ultrasound-guided liver biopsy + immunohistochemistry can help diagnose. Radical surgery is the preferred method for hepatic sarcomatoid carcinoma, and postoperative adjuvant chemotherapy is expected to prolong patient survival.

Sarcomatoid hepatocellular carcinoma versus conventional hepatocellular carcinoma: a systematic review and meta-analysis

BACKGROUND

Sarcomatoid hepatocellular carcinoma (SHCC) is a rare subtype of primary liver malignancies and is still ill-defined and poorly understood. Therefore, our study was performed to have a comprehensive evaluation SHCC versus conventional hepatocellular carcinoma (HCC).

METHODS

A thorough database searching was performed in PubMed, EMBASE and the Cochrane Library. RevMan5.3 and Stata 13.0 software were used for statistical analyses. The primary endpoint of our analysis is the long-term survival and the secondary endpoint is clinical and pathological features.

RESULTS

Four studies with a relative large cohort were finally identified. Compared with patients with pure HCC, patients with SHCC had a significantly worse overall survival (P < 0.00001) and disease-free survival (P < 0.0001). Moreover, a larger tumor size (P = 0.003), a higher incidence of node metastasis (P < 0.00001) and a higher proportion of advanced lesions (P = 0.04) were more frequently detected in patients with SHCC. Higher levels of serum ALT (P = 0.02) and TB (P = 0.005) were detected in patients with HCC rather than SHCC, while serum ALB (P = 0.02) level was relatively higher in patients with SHCC. For other measured outcomes, including concurrent viral hepatitis, liver cirrhosis, liver storage (Child A/B), multifocal tumors, vascular invasion and preoperative AFP level, the results showed no significant difference (P > 0.05).

CONCLUSION

SHCC has a worse prognosis and exhibits more aggressively than conventional HCC. Future large well-designed studies are demanded for further validation.

Preoperative prealbumin-to-fibrinogen ratio predict Survival Outcomes in hepatocellular carcinoma patients after hepatic resection

Background

This study aimed to evaluate the clinical application of the preoperative prealbumin-to-fibrinogen ratio (PFR) in the clinical diagnosis of hepatocellular carcinoma (HCC) patients and its prognostic value.

Methods

The clinical and laboratory data of 269 HCC patients undergoing surgical treatment from January 2012 to January 2017 in Taizhou Hospital were retrospectively analysed. The Cox regression model was used to analyse the correlation between the PFR and other clinicopathological factors in overall survival (OS) and disease-free survival (DFS).

Results

Cox regression analysis showed that the PFR (hazard ratio (HR)=2.123; 95% confidence interval (95% CI), 1.271-3.547; P=0.004) was an independent risk factor affecting the OS of HCC patients. Furthermore, a nomogram was built based on these risk factors. The C-index for the OS nomogram was 0.715.

Conclusions

Nomograms based on the PFR can be recommended as the correct and actual model to evaluate the prognosis of patients with HCC.

Clinical and imaging characteristics of primary hepatic sarcomatoid carcinoma and sarcoma: a comparative study

Background

Primary hepatic sarcomatous carcinoma (PHSC) and primary hepatic sarcoma (PHS) are rare malignancies with frequent overlap in both the clinic and radiology. No comparative study of these tumors for the restricted cases has previously been undertaken. The purpose of our study was to analyze the clinical and imaging features of PHSCs and PHSs, with an emphasis on particularities and similarities through a comparison of the two tumors.

Methods

We retrospectively analyzed the clinical and imaging features of 39 patients with pathologically proven PHSCs (n = 23) and PHSs (n = 16) from four university centers over a 9-year period from 2010 to 2019. Univariate analyses were performed to determine the consistent and distinctive features.

Results

The background of chronic hepatitis or cirrhosis was observed with a high frequency in both of PHSCs (73.7%) and PHSs (62.5%). Tumors with a diameter greater than 10 cm were significantly more common in PHSs than PHSCs (p = 0.043) and cystic masses were more detected in PHSs (P = 0.041). Both PHSCs and PHSs mainly presented hypovascularity (78.3% vs 81.3%). The ring hyper enhancement on the arterial phase (AP) and wash out were more frequently seen in PHSCs and the iso-hypo enhancement on the AP followed persistent or progressive enhancement was more commonly detected in PHSs (all, p < 0.05).

Conclusion

PHSC and PHS generally present as mass lesions with hypovascularity. The ring hyper enhancement on the AP and wash out favor the diagnosis of PHSC. The large size greater than 10 cm, cystic lesion, iso-hypo persistent or progressive enhancement pattern might suggest the possibility of PHSs.

A rare case of hepatic sarcomatoid carcinoma: exceeding expectations in a stage IV primary hepatic sarcomatoid carcinoma patient

A 41-year-old man was admitted to the hepatobiliary surgery department of West China Hospital for right upper abdominal pain lasting for more than three months. The local hospital's abdominal computed tomography (CT) showed an unclear low density shadow in the right and lateral lobes of the liver and nodules on the abdominal wall. A histologic analysis of an ultrasound guided percutaneous hepatic biopsy revealed it was hepatic sarcomatoid carcinoma (HSC). This stage IV highly aggressive liver cancer patient received chemotherapy, radiotherapy, and thermotherapy at the same time. An important result of this treatment was the rapid relief of pain and symptoms of nausea, vomiting, and decreased appetite. His quality of life improved quite a lot. Clinicians and patients usually have negative attitudes when they face stage IV cancer, especially in cases like this one. Through multimodal anti-tumor treatment, the patient felt much better and became more cooperative, which gave both the clinicians and the patient more confidence in the treatment and produced a better than expected outcome. We summarize the treatment of this rare case in order to share the experience and affirm confidence in both patients and clinicians in treating this condition.

Imaging and clinical features of primary hepatic sarcomatous carcinoma

Background

Primary hepatic sarcomatous carcinoma (PHSC) is a rare malignancy composed of both carcinomatous (either hepatocellular or cholangiocellular) and sarcomatous components. The purpose of our study was to evaluate the imaging and clinical findings of PHSCs, improving the understanding and diagnosis of tumors.

Methods

We retrospectively reviewed the imaging and clinical findings of ten patients with pathologically proven PHSCs, including two cases of sarcomatous intrahepatic cholangiocarcinoma (S-ICC), seven cases of sarcomatous hepatocellular carcinoma (S-HCC) and one case of sarcomatous combined hepatocellular and cholangiocarcinoma (S-HCC–CC). Six patients underwent computed tomography (CT) scans and five underwent magnetic resonance imaging (MRI) scans with one of them having both CT and MRI scans.

Results

Eight of ten patients had a background of chronic hepatitis or cirrhosis. The elevation of alpha-fetoprotein (AFP) was positive in half of the patients. All the tumors were located near the liver subcapsular area and six of ten cases were massive with round or oval shapes and ill-defined. The lesion textures were mainly heterogeneous in eight tumors for the necrosis or hemorrhage. Eight tumors showed hypo-enhancement and nine tumors exhibited initial peripheral rim (five cases) or heterogeneous (four cases) enhancement, followed by progressive (six cases) and peripheral or partial washout (three cases) on the later phases. Of the seven surgically resected tumors, five showed liver capsular invasion with one of them rupturing into the perihepatic space. Vascular thrombosis (five cases), intrahepatic metastasis (four cases), adjacent organ invasion or seeding (three cases), and lymph node metastasis (four cases) were found on imaging or in pathology. The follow-up period ranged from one to 36 months. Four patients with T3-T4 staging died from recurrence and metastasis between 2 and 5 months, and three patients with T1 staging did not have any recurrence between 16 and 24 months.

Conclusion

PHSC generally presents as a subcapsular mass with hypovascularity and may be characterized by rim-like or heterogeneous enhancement on the arterial phase and a progressive dynamic pattern. These tumors usually coincide with chronic hepatitis or cirrhosis and poor prognosis appears to be associated with TNM staging.

Clinicopathological features and surgical outcomes of four rare subtypes of primary liver carcinoma

OBJECTIVE

This study aimed to analyze clinicopathological and prognostic features of four rare pathological subtypes of primary liver malignancies to make better understanding of their clinical features.

METHODS

The clinicopathological data of 114 patients who were diagnosed with histologically proven four subtypes: clear cell carcinoma (CCC), giant cell carcinoma (GCC), sarcomatoid carcinoma (SC), and combined hepatocellular-cholangiocarcinoma (CHC) between October 1998 and August 2015 were reviewed. Their survival data were compared with those of 908 patients with histologically proven common hepatocellular carcinoma (HCC) (early- and advanced-stage HCC) during the same period.

RESULTS

The outcome of the CCC group was better than that of the other three subgroups, and was similar to that of the early-stage HCC group. Also, the smallest tumor size and the highest incidence of pseudocapsule formation were observed in the CCC group. The SC group had the worst outcome among these four subgroups; the prognosis was much poorer than that of any other subgroups, even poorer than that of the advanced-stage common HCC group. No statistical difference was observed between the GCC, CHC and advanced-stage HCC groups on survival analysis. The incidences of tumor vascular emboli, TNM staging and non-radical resection were three risk factors of the prognosis.

CONCLUSIONS

CCC is a low-degree malignancy and relatively favorably prognostic subtype of HCC. However, GCC, SC, and CHC are three rare high-degree malignancy subtypes of HCC with poor prognosis.

The prognosis of subsequent surgical treatment in patients with sarcomatoid carcinoma in the liver: A retrospective study

BACKGROUND

Sarcomatoid hepatocellular carcinoma (SHC) is a rare disease with a poor prognosis. Due to the scarcity of patients with this condition, the optimal treatment for SHC has not been established. In this study, we compared the benefits of subsequent treatments for surgical SHC patients.

MATERIALS AND METHODS

Clinical records were retrospectively studied. The SHC patients were divided into two groups according to whether subsequent treatment was performed. The overall survival (OS) rates and disease-free survival (DFS) rates were estimated by the Kaplan-Meier method, and comparisons were made using the log-rank test. Univariate and multivariate analyses were evaluated using the Cox proportional hazards regression model.

RESULTS

The study included 25 patients; 9 (36%) had subsequent treatments following surgery. The median OS of the treatment group and non-treatment group were 8.8 months [95% confidence interval (CI) 8.4-9.1] and 5.4 months [95% CI 4.3-6.5], respectively. OS showed statistical significance between the two groups (log-rank, P = 0.025). Univariate analysis suggested that two factors were poor predictors of OS: without subsequent treatment and with capsule formation. Multivariate analysis demonstrated that only subsequent treatment significantly influenced OS.

CONCLUSION

After surgery, SHC patients with subsequent treatment showed better outcomes. However, a more effective treatment is yet to be found. Further studies with a larger patient population are needed.

A Rare Case of Primary Sarcomatous Hepatocellular Carcinoma Without Previous Anticancer Therapy

Primary sarcomatous hepatocellular carcinoma (PSHCC) is a rare and aggressive variety of hepatocellular carcinoma (HCC). The recent evidence suggests that anticancer therapy promotes the dedifferentiation of the carcinomatous component and is largely responsible for this aggressive variant of HCC. However, in the absence of any anticancer therapy, occurrence of PSHCC is extremely rare. Herein, we present a rare case report of a 65 year old male patient, with a hepatitis B positive status, presenting with PSHCC without any history of anticancer therapy. Detailed immunohistochemical evaluation of the tumor was performed with comparison of morphological and immunohistochemical features of the sarcomatous and carcinomatous components. This appears to be the first documented case of PSHCC from India, to the best of our knowledge.

Sarcomatoid carcinoma of the common bile duct: A case report

RATIONALE

Sarcomatoid carcinoma is an extremely rare lesion in the common bile duct (CBD).

PATIENT CONCERNS

We present a case of sarcomatoid carcinoma of the distal CBD in a 51-year-old woman who presented with jaundice and abdominal pain. Whipple's operation was performed successfully. Microscopically, the tumor was a poorly differentiated carcinoma containing a component of sarcoma-like differentiation. The tumor cells displayed spindle-shaped nuclei with occasional mitotic figures. Cytokeratin (CK) 7, CK19, CK18, and pan-CK (AE1/AE3) staining was positive on immunohistochemistry. Vimentin and carcinoembryonic antigen (CEA) staining were also positive.

DIAGNOSES

Sarcomatoid carcinoma of the distal CBD.

INTERVENTIONS

The patient received three cycles of chemotherapy after surgery.

OUTCOMES

The patient has experienced no adverse events in the 3 years post-surgery.

LESSONS

We present here a case report of sarcomatoid carcinoma of the distal CBD. The patient received chemotherapy after surgery, and was event-free for 3 years post-surgery, suggesting a relatively better prognosis, despite the infiltrative pattern of the tumor.