Abstract
A 61-year-old male was admitted to our hospital because of an asymptomatic liver tumor and common kileduct stone which were detected during treatment of chronic heart failure. Abdominal CT scan showed a liver mass occupying S4, 5, and 8 of the liver. The rim surface of the tumor was focally enhanced by contrast media and the internal area was revealed as a homogeneous low density area without contrast enhancement, suggesting non-typical hepatocellular carcinoma. Blood examinations showed moderately impaired liver function without any hepatitis virus infection. Upon laparotomy, the liver mass had ruptured and directly invaded the subphrenic membrane with extensive peritoneal dissemination. We determined that curative surgery was impossible. Biopsies of the tumor and normal liver tissue and choledochotomy were performed. Pathological findings revealed that the tumor cells had large atypical nuclei, and its growth pattern was not arranged in hepatic cords. Immunohistochemical studies showed marked positivities for vimentin, cytokeratin AE1/AE3, and CD10. Sarcomatoid hepatoma was thus diagnosed. Despite TAE, the tumor grew rapidly and he eventually died 4 months after the initial diagnosis. Hepatocellular carcinoma with sarcomatous features such as central necrosis has a higher malignant potential than usual HCC. Radical resection seems to be the curative treatment of choice, although its therapeutic effect is limited.
