Patient underwent a percutaneous biopsy under ultrasound guidance.

Histology

MICROSCOPIC DESCRIPTION:

Sections show five core biopsies in which there is a pleomorphic tumour comprising sheets of epithelioid and spindled tumour cells. The cells have irregularly circumscribed nuclei with unevenly distributed chromatin and large, eosinophilic nucleoli. The cells have a moderate amount of amphophilic, wispy cytoplasm. In some areas, intracytoplasmic vacuoles are present. There are frequent atypical mitotic figures and foci of necrosis.

On immunohistochemistry, the tumour cells are CD99+, BCL2+ (patchy), CKAE1/AE3+ (very weak and focal), CD31+, CK7-, CK20-, S100- and CD34-.

OPINION: Core biopsy showing liver parenchyma extensively replaced by mature tumour comprised of a proliferation of atypical spindle and polygonal cells with large irregular hyperchromatic nuclei. Some focal CD31 positivity is noted. 

DIAGNOSIS: Sarcomatoid tumour in keeping with a carcinosarcoma arising in liver.

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