Abstract
Sarcomatoid hepatocellular carcinoma is a rare histologic variant of primary liver cancer comprising of malignant spindle cells and typical hepatocellular carcinoma (HCC). In terms of clinical presentation, they usually exhibit extensive tumor burden due to their larger size and a metastatic disease at the time of diagnosis as compared to conventional HCC. Tumor lysis syndrome is an oncological emergency, usually seen after cytotoxic chemotherapy in haematological malignancies. Here, we highlight a case of 76-year old male with no comorbidities, presenting with an excruciating backache and a paravertebral soft tissue mass and multiple osteolytic lesions, was clinically suspected to be a plasma cell neoplasm. On further evaluation, the patient was diagnosed of a sarcomatoid variant of hepatocellular carcinoma. This report showcases multiple rare findings by the presence of non-specific symptoms, non-cirrhotic liver, normal serum alpha protein levels and the occurrence of a spontaneous tumor lysis syndrome in a solid malignancy.
Similar content being viewed by others
References
Liao SH, Su TH, Jeng YM et al (2019) Clinical manifestations and outcomes of patients with sarcomatoid hepatocellular carcinoma. Hepatology 69:209–221. https://doi.org/10.1002/hep.30162
Kojiro M, Sugihara S, Kakizoe S, Nakashima O, Kiyomatsu K (1989) Hepatocellular carcinoma with sarcomatous change: a special reference to the relationship with anticancer therapy. Cancer Chemother Pharmacol 23(Suppl):S4–S8. https://doi.org/10.1007/BF00647229
Desai A, Sandhu S, Lai JP, Sandhu DS (2019) Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review. World J Hepatol 11:1–18. https://doi.org/10.4254/wjh.v11.i1.1
Obara K, Matsumoto N, Okamoto M et al (2008) Insufficient radiofrequency ablation therapy may induce further malignant transformation of hepatocellular carcinoma. Hepatol Int 2:116–123. https://doi.org/10.1007/s12072-007-9040-3
Marijon H, Dokmak S, Paradis V et al (2011) Epithelial-to-mesenchymal transition and acquired resistance to sunitinib in a patient with hepatocellular carcinoma. J Hepatol 54:1073–1078. https://doi.org/10.1016/j.jhep.2010.11.011
Helal TE, Aref A, Gomaa AI et al (2022) Epithelial-Mesenchymal Transition Markers in HCV Associated Hepatocellular Carcinoma: A Multivariate Follow Up Study. Asian Pac J Cancer Prev 23:839–849. https://doi.org/10.31557/APJCP.2022.23.3.839
Cairo MS, Bishop M (2004) Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 127:3–11. https://doi.org/10.1111/j.1365-2141.2004.05094.x
Chen L, Ruan S, Wang P et al (2023) Imaging features of primary hepatic sarcomatoid carcinoma: Differentiation from hepatocellular carcinoma and intrahepatic cholangiocarcinoma on CT: A preliminary study. Heliyon 9:e14123. https://doi.org/10.1016/j.heliyon.2023.e14123
Talbot JN, Fartoux L, Balogova S et al (2010) Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med 51:1699–1706. https://doi.org/10.2967/jnumed.110.075507
Giunchi F, Vasuri F, Baldin P, Rosini F, Corti B, D’Errico-Grigioni A (2013) Primary liver sarcomatous carcinoma: report of two cases and review of the literature. Pathol Res Pract 209:249–254. https://doi.org/10.1016/j.prp.2013.01.005
Giannis D, Morsy S, Geropoulos G, Esagian SM, Sioutas GS, Moris D (2021) The Epidemiology, Staging and Outcomes of Sarcomatoid Hepatocellular Carcinoma: A SEER Population Analysis. In Vivo 35:393–399. https://doi.org/10.21873/invivo.12270
Hwang S, Lee SG, Lee YJ et al (2008) Prognostic impact of sarcomatous change of hepatocellular carcinoma in patients undergoing liver resection and liver transplantation. J Gastrointest Surg 12:718–724. https://doi.org/10.1007/s11605-007-0393-7
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Contributions
Conceptualization: RC, AV, SR, JS, MAO.
Data curation: RC, JS.
Project administration: AV, SR, JS.
Writing-original draft: RC, MAO.
Writing-review & editing: RC, MAO.
Approval of final manuscript: RC, AV, SR, JS, MAO.
Corresponding author
Ethics declarations
Ethical Standards
For this case report, formal consent from a local ethics committee is not required.
Patient Consent
The authors certify that they have obtained the appropriate consent from the patient. The patient has given his consent for the images and other clinical information to be reported in the journal. The patient understands that the name and initials will not be published, and due efforts have been made to conceal the same.
Conflict of Interests
The authors declare that they have no potential conflicts of interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chhabra, R., Vidushi, A., Rajpurohit, S. et al. Spontaneous Tumor Lysis Syndrome in a Case of Hepatocellular Carcinoma with Sarcomatoid Differentiation. Indian J Surg Oncol 15, 370–374 (2024). https://doi.org/10.1007/s13193-024-01895-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-024-01895-0