Abstract
BackgroundCarcinosarcoma of the liver is a very rare tumor composed of a mixture of carcinomatous and sarcomatous elements. Less than 25 adequately documented cases have been reported, with inadequate description of imaging features. In order to improve the awareness of this rare tumor, this study aimed to analyze the clinicopathologic and imaging features of six cases of hepatic carcinosarcoma (HCS) confirmed by surgical pathologic evaluation.MethodsWe retrospectively studied the clinicopathologic and imaging features of six cases of HCS (matching the World Health Organization definition) and discussed the differential diagnosis on the basis of imaging findings. The patients, including five men and one woman, were 38 to 69 years of age. Five patients underwent CT scans, one underwent MRI scans.ResultsWhile 3 patients were positive for hepatitis-B surface antigen, 2 had cirrhosis. The largest tumor diameter ranged from 5.0 to 21.0 cm. Satellite nodules, venous thrombi, and organ invasion (gastric wall, gallbladder, and right adrenal gland) were identified. Pathologically, the carcinomatous components corresponded to hepatocellular carcinoma in three cases, cholangiocellular carcinoma in one case, and adenocarcinoma in two cases. The sarcomatous components exhibited complex features, with undifferentiated spindle cells in five cases and a leiomyosarcoma in one. All tumors showed heterogeneous density/intensity with extensive cystic change and necrosis; spot calcification was observed in one case. Capsule was not identified. While four tumors showed heterogeneous hypervascular enhancement, two showed hypovascular enhancement. All patients underwent surgical resection. The follow-up period ranged from 2 to 18 months. Four patients died from recurrence and metastasis.ConclusionsThe clinical and imaging features of HCS are heterogeneous. Due to the heterogenous nature and very low morbidity of HCS, combination of careful analysis of imaging findings and clinical features might be useful for a more accurate diagnosis of HCS.
Highlights
Carcinosarcoma of the liver is a very rare tumor composed of a mixture of carcinomatous and sarcomatous elements
Primary hepatic carcinosarcoma (HCS) is a very rare malignant tumor composed of a mixture of carcinomatous and sarcomatous elements [1]
Due to its more aggressive nature and poorer prognosis than pure hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC), it is clinically beneficial to narrow down the differential diagnoses by accumulating imaging findings of HCS
Summary
Carcinosarcoma of the liver is a very rare tumor composed of a mixture of carcinomatous and sarcomatous elements. Primary hepatic carcinosarcoma (HCS) is a very rare malignant tumor composed of a mixture of carcinomatous and sarcomatous elements [1]. This tumor is difficult to diagnose clinically; it is aggressive and has poor prognosis, being associated with a high frequency of early metastasis and advanced stage at diagnosis [2]. This study analyzes the imaging findings and clinical features of six cases of HCS and presents a review of the literature
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