A rare histologic subtype of hepatocellular carcinoma, sarcomatoid hepatocellular carcinoma: report of a case

Figures & data

Figure 1. Coronal MRI demonstrating the large heterogeneous exophytic hepatic mass.

MRI: Magnetic resonance imaging.

Figure 2. Histologic and immunophenotypic findings of sarcomatoid hepatocellular carcinoma as seen on the diagnostic biopsy.

(A) At low magnification, the biphenotypic histology of sarcomatoid and conventional hepatocellular components is evident in the patient’s core needle biopsy specimen (green arrow head – conventional HCC component; black arrowhead – sarcomatoid component) (H&E 40× magnification). (B) Higher magnification shows widened plates of neoplastic hepatocytes (green arrowheads) and adjacent areas of spindled and bizarrely shaped sarcomatoid cells (black arrowheads) (H&E 100× magnification). (C) Higher magnification of sarcomatoid component with bizarre multinucleated giant cells (green arrowheads) (H&E 200× magnification). (D) The conventional HCC component (green arrowheads) is positive for HepPar1 IHC stain but the sarcomatoid component (black arrowheads) is negative (100× magnification). (E) The conventional HCC (green arrowheads) is positive for arginase 1 IHC stain but the sarcomatoid component (black arrowheads) is negative (100× magnification). (F) The conventional HCC (green arrowheads) is positive for cytokeratin CAM5.2 IHC with patchy positivity seen in the sarcomatoid component (black arrowheads) (100× magnification). (G) The conventional HCC is positive for cytokeratin AE1/AE3 IHC (green arrowheads) with patchy positivity seen in the sarcomatoid component (black arrowheads) (100× magnification). (H) The absence of staining for vimentin in the conventional HCC component (green arrowheads) stands in sharp contrast to the strong positivity of the sarcomatoid component (white arrowheads) (100× magnification). (I) Patchy positivity for cytokeratin AE1/AE3 present in this area of tumor only displaying sarcomatoid features is seen (100× magnification).

H&E: Hematoxylin and eosin; HCC: Hepatocellular carcinoma; IHC: Immunohistochemical.

Figure 3. Gross and histologic findings of sarcomatoid hepatocellular carcinoma resection specimen.

(A) A gross photograph of the resection specimen shows a variegated multinodular tumor with firm cream colored areas, yellow areas of necrosis that comprise about 25% of the tumor and areas of hemorrhage. Focal background cirrhotic liver is seen at the bottom right of the image. (B) Histologic examination of the patient’s resection specimen confirmed a predominantly sarcomatoid neoplasm with focal areas of conventional hepatocellular differentiation (H&E 100× magnification). (C) Higher magnification shows neoplastic epithelioid tumor cells surrounded by malignant spindled sarcomatoid cells (H&E 200 × magnification). (D) Cirrhotic background hepatic parenchyma (H&E × 40 magnification).