Spindle cell hepatocellular carcinoma

Spindle cell hepatocellular carcinoma, also called sarcomatoid hepatocellular carcinoma, is a rare variant of hepatocellular carcinoma (HCC). These patients are reported to have low or normal AFP levels, otherwise risk factors and clinical presentation are similar to typical hepatocellular carcinoma.

Epidemiology

The spindle cell variant occurred in ~2% of surgically resected hepatocellular carcinoma specimens ^1,2.

Pathology

Spindle cell HCC is thought to arise either sporadically, or more commonly degenerate from an existing HCC secondary to therapies such as transcatheter arterial chemoembolisation (TACE), radiofrequency (RF) ablation, or percutaneous ethanol injection ². 

Histology

A variable percentage of the tumor contains spindle-shaped cells forming interlacing bundles. This is thought to represent sarcomatous differentiation of hepatocellular carcinoma.

Radiographic features

Currently, there are no specific imaging features and cases are diagnosed retrospectively. Refer on the main article of HCC for a broad discussion on imaging features of this condition.  

Treatment and prognosis

There is no standard treatment. The difference between typical hepatocellular carcinoma and the spindle cell variant is uncertain, but prognosis is thought to be poor, partly because metastasis is thought to be more common in the spindle cell variant ¹.