Abstract
A 75-year-old man was diagnosed with multiple recurrent hepatocellular carcinomas after repeated local therapies, including transcatheter arterial chemoembolization and radiofrequency ablation. Computed tomography showed a local recurrence of the tumor involving the right diaphragm. Central bisegmentectomy and partial resection of the diaphragm was performed. Histopathological examination revealed that the tumor consisted of a well to poorly differentiated adenocarcinoma with a spindle-shaped sarcomatous component and positive surgical margins. Immunohistologically, the tumor was positive for CK19, thus, he was diagnosed as having intrahepatic cholangiocarcinoma with sarcomatous change. He developed a local recurrence 1 year after the first operation, and underwent partial resection of the diaphragm combined with the right lower lung. Six months after the second operation, he developed a recurrence in the mediastinal lymph node. It is sometimes difficult to differentiate small intrahepatic cholangiocarcinoma from hapatocellular carcinoma. As with our case, repeated local therapies for liver tumors might have chance to cause sarcomatous change. Clinically, it is difficult to diagnose sarcomatous change, and an aggressive surgical treatment is necessary in the case of recurrence hepatic tumors after repeated local therapies.
