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.
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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 tumour 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.
Related articles
Hepatobiliary pathology
- depositional disorders
- infection and inflammation
- liver abscess
- hepatic hydatid infection
- cirrhosis
- hepatitis
- cholecystitis
- cholangitis
- malignancy
- liver and intrahepatic bile duct tumours
- benign epithelial tumours
- hepatocellular hyperplasia
- hepatocellular adenoma
- hepatic/biliary cysts
- benign nonepithelial tumours
- primary malignant epithelial tumours
- hepatocellular carcinoma
- hepatocellular carcinoma variants
- cholangiocarcinoma
- biliary cystadenocarcinoma
- combined hepatocellular and cholangiocarcinoma
- hepatoblastoma
- undifferentiated carcinoma
- primary malignant nonepithelial tumours
- haematopoietic and lymphoid tumours
- primary hepatic lymphoma
- hepatic myeloid sarcoma (hepatic chloroma)
- secondary tumours
- miscellaneous
- adrenal rest tumours
- hepatic carcinosarcoma
- hepatic fibroma
- hepatic Kaposi sarcoma
- hepatic lipoma
- hepatic mesenchymal hamartoma
- hepatic myxoma
- hepatic rhabdoid tumour
- hepatic solitary fibrous tumour
- hepatic teratoma
- hepatic yolk sac tumour
- inflammatory myofibroblastic tumour (inflammatory pseudotumor)
- nodular regenerative hyperplasia
- pancreatic rest tumours
- primary hepatic carcinoid
- benign epithelial tumours
- extrahepatic bile duct tumours
- extrahepatic bile duct cholangiocarcinoma
- hilar cholangiocarcinoma (Klatskin tumour)
- extrahepatic bile duct cholangiocarcinoma
- liver and intrahepatic bile duct tumours
- metabolic
- trauma
- vascular
- portal venous gas
- portal hypertension
- portal vein thrombosis
- arterioportal shunts
- hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
- Budd-Chiari syndrome
- passive hepatic congestion
- hepatic veno-occlusive disease
- hepatic infarction
- peliosis hepatis
- hepatic venous malformations (haemangiomas)
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