Combined sarcomatoid hepatocellular and cholangiocarcinoma: a case report and literature review

Abstract

Hepatic sarcomatoid carcinomas are very rare. The majority of cases contain sarcomatoid features with either hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC) elements alone. These are aggressive tumors and carry an unfavorable prognosis. We describe an extremely rare tumor sub-type of combined sarcomatoid HCC and CC in a hepatitis B virus carrier presenting with abdominal pain. Pre-operative imaging suggested a segment VI hepatocellular cancer with no metastatic spread. En bloc surgical resection with the right adrenal gland, Gerota's fascia and right hemidiaphragm was performed. The patient suffered early peritoneal tumor recurrence and lymph node metastasis. Pre-operative diagnosis of such sarcomatoid tumors is difficult. Current evidence for adjuvant treatment is also limited. Prognosis of these patients remains extremely poor, and surgery appears to be the only curative option in cases of early disease. It is essential that clinicians carry a high index of suspicion and awareness of this rare pathological entity to improve patient outcome.