Hepatic carcinosarcoma

Case contributed by Henry Knipe
Diagnosis certain

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. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.