Hepatic carcinosarcoma

Case contributed by Dr Henry Knipe

Presentation

Abdominal discomfort.

Patient Data

Age: 60 years
Gender: Female
CT

Large mass measuring up to 9 cm in liver segment 2/3. Further multiple smaller hypodensities throughout the remainder of the liver, which are variable attenuation (between 20 HU and 60 HU).

Ultrasound

Large liver segment 2/3 mass, which is hypoechoic compared to adjacent liver with internal vascularity.

Small hepatic and right renal cysts. 

Patient underwent a percutaneous biopsy under ultrasound guidance.

Histology

MICROSCOPIC DESCRIPTION:

Sections show five core biopsies in which there is a pleomorphic tumor comprising sheets of epithelioid and spindled tumor 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 tumor 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 tumor comprised of a proliferation of atypical spindle and polygonal cells with large irregular hyperchromatic nuclei. Some focal CD31 positivity is noted. 

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

Case Discussion

Hepatic carcinosarcoma is a very rare tumor. There are no specific imaging features to suggest this diagnosis. Histology shows a mixture of carcinomatous and sarcomatous elements. 

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