Abstract
IntroductionHepatic sarcomatoid carcinoma (HSC) is a rare type of liver cancer with a high malignant grade and poor prognosis. This study compared the clinical characteristics and magnetic resonance imaging (MRI) features of HSCs with those of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), aiming to identify valuable features for HSC diagnosis.MethodsIn total, 17 pathologically confirmed HSC cases, 50 HCC cases and 50 common ICC cases were enrolled from two hospitals. The clinical characteristics and MRI features of all cases were summarized and statistically analyzed.ResultsOn the one hand, the incidence rates of elevated carbohydrate antigen (CA) 19-9 and elevated carcinoembryonic antigen (CEA) were significantly higher in the HSC cases than in the HCC cases (29.4% vs. 0%; 17.6% vs. 0%). The HSC enhancement patterns, primarily including progressive enhancement, were also significantly different from HCC cases. The incidence rates of heterogeneous signals on T2-weighted imaging and during the arterial phase were significantly higher in the HSC cases than in the HCC cases (94.1% vs. 66.0%; 100.0% vs. 72.0%). The diameter of HSCs was significantly larger than that in the HCC cases (6.12 cm vs. 4.21 cm), and the incidence rates of adjacent cholangiectasis, intrahepatic metastasis and lymph node enlargement were considerably higher in the HSC cases than in the HCC cases (52.9% vs. 6.0%; 47.1% vs. 12.0%; 41.2% vs. 2.0%). On the other hand, the incidence rate of elevated CA199 was significantly lower in the HSC cases than in the ICC cases (29.4% vs. 60.0%). The incidence rates of intratumoral necrosis and pseudocapsules were significantly higher in the HSC cases than in the HCC cases (35.3% vs. 8.0%; 47.1% vs. 12.0%). However, the incidence rates of target signs were significantly lower in the HSC cases than in the HCC cases (11.8% vs. 42.0%). In addition, there was no significant difference in the enhancement patterns between HSC cases and ICC cases.ConclusionsHSCs were frequently seen in elderly men with clinical symptoms and elevated CA199 levels. The MRI features, including large size, obvious heterogeneity, hemorrhage, progressive enhancement, pseudocapsule and lymph node enlargement, contributed to the diagnosis of HSC.
Highlights
Hepatic sarcomatoid carcinoma (HSC) is a rare type of liver cancer with a high malignant grade and poor prognosis
The 17 HSC cases consisted of 14 men and 3 women
There were no significant differences in number, tumor site, maximum diameter, morphology, signal intensity and heterogeneity (T1WI, T2WI, diffusion weighted imaging (DWI)), tumor boundary, adjacent cholangiectasis, intratumoral necrosis, arterial phase enhancement, arterial phase enhancement consistency, abnormal perfusion, peripheral wash-in and wash-out, hepatic capsular retraction (HCR), vein tumor thrombus, enhancement pattern, mosaic sign, intrahepatic metastasis or lymph node enlargement between the HSC and intrahepatic cholangiocarcinoma (ICC) groups
Summary
Hepatic sarcomatoid carcinoma (HSC) is a rare type of liver cancer with a high malignant grade and poor prognosis. Hepatic sarcomatoid carcinoma (HSC) is a rare malignant tumor that accounts for less than 4% of liver cancers (1). The pathological features of HSCs are dominated by the proliferation of spindle cells and polymorphic cells, manifesting alternate permutation with acini (2). There are two opinions about the pathogenesis of HSC, including the sarcomatoid transformation of hepatocellular carcinoma (HCC), which is more widely accepted, and the combination of liver cancer with sarcoma (3). The clinical manifestations of HSC patients are dominated by abdominal pain, followed by fatigue, fever and jaundice (7). HSCs are poorly differentiated, and half of cases are pathological grades III and IV (4, 6). It is important to analyze the imaging features of HSCs for the formulation of individualized therapeutic strategies
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