Presentation
Abdominal discomfort.
Patient Data
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).
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.