Hepatobiliary and pancreatic: Huge hepatic carcinosarcoma
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
24
Journal Issue
5
Pages
929
Date Issued
2009
Author(s)
Abstract
A 52-year-old man was admitted to hospital because of persistent abdominal pain for 4 days. He gave a history of alcohol abuse over several years. On examination, his abdomen was distended and he had a relatively large mass, apparently in the mid-abdomen. Blood tests revealed a minor elevation of aspartate aminotransferase and alanine aminotransferase but his serum alpha fetoprotein was markedly elevated at 4091 ng/ml (R < 20 ng/ml). An abdominal ultrasound study revealed a large abdominal tumor. A contrast-enhanced abdominal computed tomography scan confirmed the presence of a large tumor with rupture of the liver capsule and radiological features consistent with both carcinomatous (black arrow) and sarcomatous (red arrow) components (Figure 1). At laparotomy, he had a large mass, 20 × 25 cm in size (Figure 2), that was successfully removed without the need for a major blood transfusion. Histology revealed a carcinosarcoma. The operation was performed without complication and he is currently being reviewed in our out-patient clinic. The most common primary malignant tumors of the liver are hepatocellular carcinoma, intrahepatic cholangiocarcinoma and hepatoblastoma. Rare miscellaneous malignant tumors include nonhepatocytic malignant mixed tumors, yolk sac tumors, rhabdoid tumors and primary carcinoid tumors. There are also malignant mesenchymal tumors including various sarcomas and primary hepatic lymphomas. One characteristic of sarcomas is that they are often relatively large at the time of diagnosis. For example, embryonal sarcomas, fibrosarcomas and leiomyosarcomas can reach 30-40 cm in size and weigh up to 7 kg. Carcinosarcomas are extremely rare mixed malignant neoplasms with fewer than 20 cases in the English literature. Patients are usually men with a mean age of approximately 60 years. Presenting features can include abdominal pain, jaundice and fever. Extrahepatic metastases are common at the time of diagnosis and the prognosis appears to be poor. In patients with true carcinosarcomas, epithelial elements should be glandular rather than hepatocellular and should be mixed with a poorly-differentiated spindle cell tumor. However, difficulties may be encountered in differentiating carcinosarcomas from variants of hepatocellular carcinoma and cholangiocarcinoma that show spindle cell or ‘sarcomatoid’ change.
SDGs
Other Subjects
abdominal radiography; adult; article; cancer diagnosis; cancer surgery; carcinosarcoma; case report; clinical feature; computer assisted tomography; human; human tissue; laparotomy; male; priority journal; cancer invasion; carcinosarcoma; liver resection; liver tumor; middle aged; pathology; radiography; treatment outcome; Carcinosarcoma; Hepatectomy; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Tomography, X-Ray Computed; Treatment Outcome
Publisher
Blackwell Publishing
Type
journal article