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A case of primary carcinosarcoma of the liver with combined hepatocellular carcinoma and cholangiocarcinoma

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Abstract

Primary carcinosarcoma of the liver is extremely rare. Here, we report an unusual case of carcinosarcoma of the liver containing combined hepatocellular carcinoma and cholangiocarcinoma. A 66-year-old man with a history of viral hepatitis B was admitted for investigation of multiple liver masses. Dynamic computed tomography revealed a mostly hypoenhancing main tumor with a peripheral ring enhancement and several satellite nodules. After transcatheter arterial chemoembolization and portal vein embolization, an extended right posterior sectionectomy was performed. The resected tumor was macroscopically a simple nodular type, 4.3 × 4.2 cm in diameter, with a dense fibrous capsule. The pathological findings showed that both carcinomatous and sarcomatous elements were present, and diagnosis of carcinosarcoma of the liver was confirmed. The carcinomatous element consisted of hepatocellular carcinoma and cholangiocarcinoma. The sarcomatous element was composed of spindle cells. Immunohistochemical studies demonstrated that cytokeratin AE1/AE3, human serum albumin, cytokeratin 7, and Arginase-1 were partially positive in tumor cells of the carcinomatous element but not in tumor cells of the sarcomatous element. Follow-up for 30 months after surgery has shown no signs of recurrence.

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Abbreviations

CK:

Cytokeratin

HCC:

Hepatocellular carcinoma

CCA:

Cholangiocarcinoma

cHCC-CCA:

Combined hepatocellular carcinoma and cholangiocarcinoma

CT:

Computed tomography

Gd:

Gadolinium

EOB:

Ethoxybenzyl

DTPA:

Diethylenetriamine penta-acetic acid

MRI:

Magnetic resonance imaging

AFP:

Alpha-fetoprotein

DCP:

Des-γ-carboxy prothrombin

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19 to 9

ICG-R15:

Indocyanine green retention rate at 15 min

TACE:

Transcatheter arterial chemoembolization

FLR:

Future liver remnant

PVE:

Portal vein embolization

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Takashi Ofuchi, Katsunori Imai, Yosuke Nakao, Shigeki Nakagawa, Yuta Shiraishi, Rikako Kato, Rumi Itoyama, Toshihiko Yusa, Takaaki Higashi, Hiromitsu Hayashi, Yo-ichi Yamashita & Hideo Baba

  2. Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan

    Tsuguharu Asato & Yoshiki Mikami

Authors
  1. Takashi Ofuchi
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  2. Katsunori Imai
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  3. Yosuke Nakao
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  4. Shigeki Nakagawa
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  11. Tsuguharu Asato
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  12. Yo-ichi Yamashita
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  13. Yoshiki Mikami
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  14. Hideo Baba
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Corresponding author

Correspondence to Katsunori Imai.

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The authors have no conflicts of interest in association with this study. No financial support was received for the work described in this manuscript.

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Ofuchi, T., Imai, K., Nakao, Y. et al. A case of primary carcinosarcoma of the liver with combined hepatocellular carcinoma and cholangiocarcinoma. Clin J Gastroenterol 14, 1476–1483 (2021). https://doi.org/10.1007/s12328-021-01469-5

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  • DOI: https://doi.org/10.1007/s12328-021-01469-5

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