Liver Carcinosarcoma in a Liver Transplant Recepient with History of Cholangiocarcinoma

Abstract

Purpose: We describe a case of a 62-year-old male patient with history of cirrhosis secondary to hepatitis C, for which he underwent an orthotopic liver transplant. Biopsy of explant showed cholangiocarcinoma. The patient was doing well for 5 months after transplant, before he started to develop ascites. Imaging showed radiological evidence of a complex irregular cystic lesion projecting on the under-surface of the right hepatic lobe, in addition to bilateral pulmonary nodules. A biopsy of the liver mass was done, and pathology was consistent with hepatic carcinosarcoma (high-grade malignant spindle cell neoplasm/spindle cell carcinoma. Pathology of transplanted liver biopsy: “The tumor cells are positive for factor 8 and CAM 5.2, and negative for CD31, CD34, CK5/6, S-100, P63, desmin, and CK7 immunostains. Positive factor 8 immunostain is suggestive of angiosarcoma; however, the two other vascular markers [CD31 and CD34] are negative”). Peritoneal fluid was positive for malignant cells as well. The patient had progressive clinical deterioration, and was deemed not to be a surgical candidate. The decision was made by family to pursue comfort care measures, and the patient passed away two months later. We conclude that primary hepatic carcinosarcoma is a rare, malignant tumor containing both carcinomatous and sarcomatous elements, with limited literature on epidemiology, risk factors, or treatment possibilities. The occurrence of this type of malignancy in a patient with recent liver transplant and history of cholangiocarcinoma has not been reported. It is unclear whether there is an association between the occurrence of carcinosarcoma and the history of liver transplantation or cholangiocarcinoma. Prognosis of hepatic carcinosarcoma was poor in most reported cases.FigureFigure