Advertisement

Clinical Journal of Gastroenterology

, Volume 3, Issue 2, pp 97–103 | Cite as

Hepatic carcinosarcoma with heterogeneous carcinomatous and sarcomatous elements: report of a case and review of the literature

  • Hirofumi Tazawa
  • Toshiyuki Itamoto
  • Akihiko Oshita
  • Tsuyoshi Kobayashi
  • Hironobu Amano
  • Hirotaka Tashiro
  • Hideki Ohdan
  • Shoichi Takahashi
  • Kazuaki Chayama
  • Koji Arihiro
  • Osamu Nakashima
Case Report

Abstract

We report a rare case of hepatic carcinosarcoma consisting of two carcinomatous components and four sarcomatous components. A 54-year-old Japanese man presented with sudden right upper abdominal pain. Computed tomography showed a hepatic tumor measuring 17 cm in the greatest dimension and intractable ascites, suggesting rupture of hepatocellular carcinoma (HCC). Transcatheter arterial embolization was repeated at our hospital, resulting in stabilization of the patient’s general condition. Right anterior and left median sectionectomies were performed. Histologically, the tumor consisted of carcinomatous and sarcomatous elements. The carcinomatous elements consisted of moderately differentiated HCC (positive for hepatocyte antibody, murine monoclonal anti-cytokeratin antibody, and alpha-fetoprotein and negative for S-100 and desmin) and adenocarcinoma (negative for cytokeratin 7 and positive for carcinoembryonic antigen). Sarcomatous elements consisted of undifferentiated spindle cell sarcoma, rhabdomyosarcoma with acidophil striated cells including striped cells (desmin-positive), chondrosarcoma with cartilage matrix (S-100-positive), and osteosarcoma with osteoid. The sarcomatous elements were negative for epithelial markers. The patient is alive at 34 months after the operation with peritoneal dissemination. A total of 23 cases, including the present case, of hepatic carcinosarcoma have been reported in the English language literature. This is the third reported case of hepatic carcinosarcoma with heterogeneous carcinomatous and sarcomatous elements.

Keywords

Hepatic carcinosarcoma HCC Rhabdomyosarcoma Chondrosarcoma Osteosarcoma 

References

  1. 1.
    Harris MA, Delap LM, Sengupta PS, Wilkinson PM, Welch RS, Swindell R, et al. Carcinosarcoma of the ovary. Br J Cancer. 2003;88:654–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Bodner-Adler B, Bodner K, Obermair A, Czerwenka K, Petru E, Leodolter S, et al. Prognostic parameters in carcinosarcomas of the uterus: a clinico-pathologic study. Anticancer Res. 2001;21:3069–74.PubMedGoogle Scholar
  3. 3.
    Baschinsky DY, Chen JH, Vadmal MS, Lucas JG, Bahnson RR, Niemann TH. Carcinosarcoma of the urinary bladder—an aggressive tumor with diverse histogenesis. A clinicopathologic study of 4 cases and review of the literature. Arch Pathol Lab Med. 2000;124:1172–8.PubMedGoogle Scholar
  4. 4.
    Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12:351–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Craig J, Peters R, Edmondson H. Tumors of the liver and intrahepatic bile ducts. Washington, DC: Armed Forces Institute of Pathology; 1989.Google Scholar
  6. 6.
    Ishak K, Anthony P, Niederau C. Mesenchymal tumours of the liver. In: Stanley RH, Lauri AA, editors. WHO international histological classification of tumours. Pathology and genetics of the tumours of the digestive system. Lyon: IARC Press; 2000. p. 198.Google Scholar
  7. 7.
    Ishak K, Anthony P, Sobin L. WHO international histological classification of tumours. Histological typing of tumour in the liver. 2nd ed. Berlin: Springer; 1994.Google Scholar
  8. 8.
    Rossi G, Cavazza A, Sturm N, Migaldi M, Facciolongo N, Longo L, et al. Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements: a clinicopathologic and immunohistochemical study of 75 cases. Am J Surg Pathol. 2003;27:311–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Lao XM, Chen DY, Zhang YQ, Xiang J, Guo RP, Lin XJ, et al. Primary carcinosarcoma of the liver: clinicopathologic features of 5 cases and a review of the literature. Am J Surg Pathol. 2007;31:817–26.CrossRefPubMedGoogle Scholar
  10. 10.
    Freeman AJ, Bullpitt P, Keogh GW. Primary hepatic carcinosarcoma. Aust N Z J Surg. 2004;74:1021–3.CrossRefGoogle Scholar
  11. 11.
    Kwon JH, Kang YN, Kang KJ. Carcinosarcoma of the liver: a case report. Korean J Radiol. 2007;8:343–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Nomura K, Aizawa S, Ushigome S. Carcinosarcoma of the liver. Arch Pathol Lab Med. 2000;124:888–90.PubMedGoogle Scholar
  13. 13.
    Sumiyoshi S, Kikuyama M, Matsubayashi Y, Kageyama F, Ide Y, Kobayashi Y, et al. Carcinosarcoma of the liver with mesenchymal differentiation. World J Gastroenterol. 2007;13:809–12.PubMedGoogle Scholar
  14. 14.
    Wang XW, Liang P, Li HY. Primary hepatic carcinosarcoma: a case report. Chin Med J (Engl). 2004;117:1586–7.Google Scholar
  15. 15.
    Adesina AM, Nguyen Y, Guanaratne P, Pulliam J, Lopez-Terrada D, Margolin J, et al. FOXG1 is overexpressed in hepatoblastoma. Hum Pathol. 2007;38:400–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Aiko S, Sugiura Y, Yoshizumi Y, Hiroshi K, Tomokazu M, Shinsuke A, et al. Carcinosarcoma of the liver with an osteosarcomatous component. Int J Clin Oncol. 1999;4:185–8.CrossRefGoogle Scholar
  17. 17.
    Akasofu M, Kawahara E, Kaji K, Nakanishi I. Sarcomatoid hepatocellular-carcinoma showing rhabdomyoblastic differentiation in the adult cirrhotic liver. Virchows Arch. 1999;434:511–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Carter R. Hepatoblastoma in the adult. Cancer (Phila). 1969;23:191–7.CrossRefGoogle Scholar
  19. 19.
    Kishimoto Y, Hijiya S, Nagasako R. Malignant mixed tumor of the liver in adults. Am J Gastroenterol. 1984;79:229–35.PubMedGoogle Scholar
  20. 20.
    Kubosawa H, Ishige H, Kondo Y, Konno A, Yamamoto T, Nagao K. Hepatocellular carcinoma with rhabdomyoblastic differentiation. Cancer (Phila). 1988;62:781–6.CrossRefGoogle Scholar
  21. 21.
    Leger-Ravet MB, Borgonovo G, Amato A, Lemaigre G, Franco D. Carcinosarcoma of the liver with mesenchymal differentiation: a case report. Hepatogastroenterology. 1996;43:255–9.PubMedGoogle Scholar
  22. 22.
    Maeda M, Kanayama M, Uchida T, Hasumura Y, Takeuchi J. A case of hepatocellular carcinoma associated with ossification. A case report. Cancer (Phila). 1986;57:134–7.CrossRefGoogle Scholar
  23. 23.
    Nakajima T, Kubosawa H, Kondo Y, Konno A, Iwama S. Combined hepatocellular-cholangiocarcinoma with variable sarcomatous transformation. Am J Clin Pathol. 1988;90:309–12.PubMedGoogle Scholar
  24. 24.
    Ooi A, Katsuda S, Nakanishi I, Nakamura N, Matsushita F, Tanaka N, et al. Hepatocellular carcinoma with chondrosarcomatous variation. A case report and review of the literature. Acta Pathol Jpn. 1987;37:1165–73.PubMedGoogle Scholar
  25. 25.
    She R, Szakacs J. Carcinosarcoma of the liver: a case report and review of the literature. Arch Pathol Lab Med. 2005;129:790–3.PubMedGoogle Scholar
  26. 26.
    Garcez-Silva MH, Gonzalez AM, Moura RA, Linhares MM, Lanzoni VP, et al. Carcinosarcoma of the liver: a case report. Transplant Proc. 2006;38:1918–1919.CrossRefPubMedGoogle Scholar
  27. 27.
    Stoupis C, Taylor HM, Paley MR, Buetow PC, Marre S, Baer HU, et al. The Rocky liver: radiologic–pathologic correlation of calcified hepatic masses. Radiographics. 1998;18:675–85.PubMedGoogle Scholar
  28. 28.
    Thompson L, Chang B, Barsky SH. Monoclonal origins of malignant mixed tumors (carcinosarcomas). Evidence for a divergent histogenesis. Am J Surg Pathol. 1996;20:277–85.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Hirofumi Tazawa
    • 1
  • Toshiyuki Itamoto
    • 1
  • Akihiko Oshita
    • 1
  • Tsuyoshi Kobayashi
    • 1
  • Hironobu Amano
    • 1
  • Hirotaka Tashiro
    • 1
  • Hideki Ohdan
    • 1
  • Shoichi Takahashi
    • 2
  • Kazuaki Chayama
    • 2
  • Koji Arihiro
    • 3
  • Osamu Nakashima
    • 4
  1. 1.Second Department of SurgeryHiroshima University School of MedicineHiroshimaJapan
  2. 2.Programs for Biomedical Research, Division of Frontier Medical Science, Department of Medicine and Molecular Science, Graduate School of Biomedical SciencesHiroshima University School of MedicineHiroshimaJapan
  3. 3.Central Clinical Division of Anatomical PathologyHiroshima University School of MedicineHiroshimaJapan
  4. 4.Department of PathologyKurume University School of MedicineKurumeJapan

Personalised recommendations