Carcinosarcoma de ovario en paciente perimenopáusica / Ovarian carcinosarcoma in a perimenopausal woman

Resumen ANTECEDENTES: El carcinosarcoma de ovario, o tumor mixto de Müller, es una neoplasia infrecuente que representa alrededor del 1 al 4% de los carcinomas ováricos epiteliales. Su histología combina componentes sarcomatosos y carcinomatosos. CASO CLÍNICO: Paciente de 55 años, con diagnóstico de carcinosarcoma de ovario. Acudió a consulta debido a un sangrado uterino irregular y dolor abdominal. En la ecografía transvaginal se encontró una formación anexial sólida y heterogénea de 11.95 x 10.6 cm, con captación Doppler. El estudio se amplió con una tomografía axial computada (TAC) abdominopélvica y de tórax en la que se observó una tumoración en el lado izquierdo de 18 x 13 cm. Los marcadores tumorales se reportaron elevados: CEA 10.60, CA 125 91.3 y CA19.9 153 U/mL, con proteína HE-4 86.8 pmol/L, ligeramente disminuida. La laparotomía exploradora se completó con una cirugía para eliminar toda la carga tumoral. Se indicó quimioterapia con paclitaxel-carboplatino. El estudio histológico definitivo informó la existencia de una tumoración sólida-quística, compatible con un carcinosarcoma en el ovario izquierdo, con amplia diseminación peritoneal. A los 3 meses de la intervención, la paciente continuaba sin signos de recidiva. CONCLUSIONES: El carcinosarcoma es un tumor ginecológico poco frecuente pero muy agresivo; por su excepcional hallazgo aún no se dispone de criterios de tratamiento. Es decisivo fomentar investigaciones futuras acerca de los factores pronósticos y biomarcadores y desarrollar tratamientos dirigidos a las características moleculares de cada paciente.

Abstract BACKGROUND: Ovarian carcinosarcoma, or mixed Müllerian tumor, is a rare neoplasm that represents about 1 to 4% of epithelial ovarian carcinomas. Its histology combines sarcomatous and carcinomatous components. CLINICAL CASE: 55-year-old female patient with a diagnosis of ovarian carcinosarcoma. She consulted due to irregular uterine bleeding and abdominal pain. Transvaginal ultrasound showed a solid and heterogeneous adnexal formation measuring 11.95 x 10.6 cm, with Doppler uptake. The study was expanded with an abdominopelvic and chest computed axial tomography (CT) scan in which a tumor was observed on the left side measuring 18 x 13 cm. Tumor markers were reported elevated: CEA 10.60, CA 125 91.3 and CA19.9 153 U/mL, with HE-4 protein 86.8 pmol/L, slightly decreased. Exploratory laparotomy was completed with R0 surgery. Chemotherapy with paclitaxel-carboplatin was indicated. The definitive histological study reported the existence of a solid-cystic tumor, compatible with a carcinosarcoma in the left ovary, with extensive peritoneal dissemination. Three months after surgery, the patient continued without signs of recurrence. CONCLUSIONS: Carcinosarcoma is a rare but very aggressive gynecologic tumor; because of its exceptional finding no treatment criteria are yet available. It is crucial to encourage future research on prognostic factors and biomarkers and to develop treatments targeted to the molecular characteristics of each patient.

Mullerian adenosarcoma with sarcomatous overgrowth in a premenopausal patient / Philippine Journal of Obstetrics and Gynecology

@#We report a case of a 33-years old, nulligravid, diagnosed with mullerian adenosarcoma with sarcomatous overgrowth (MASO), who presented with vaginal bleeding and recurrent endometrial polyp. MASO is a rare type of uterine sarcomas, it is a variant of adenosarcomas with poor prognosis. The index patient underwent primary surgical management with lymphadenectomy with a final stage of IC. Histologic diagnosis was Mulllerian adenosarcoma with sarcomatous overgrowth. A panel of immunostaining for estrogen receptors, progesterone receptors and CD 10 showed diffused positivity for the hormones with loss of CD 10 which is consistent with MASO. The rarity of MASO has a distinctive histologic features which merits meticulous sectioning as the clinical course and management vary. It has a poor prognosis due to its short and fast course of the disease.

Mullerian adenosarcoma (heterologous) of uterine cervix with sarcomatous overgrowth: A case report with review of the literature

Mullerian adenosarcoma is a rare biphasic malignant neoplasm of cervix characterized by an admixture of benign epithelial elements and a malignant sarcomatous stromal component, which may be either homologous or heterologous. Mullerian adenosarcoma with stromal overgrowth (MASO) in an aggressive variant of adenosarcoma, which is extremely rare with only two such cases reported till date. In this report, we present a case of MASO of cervix with heterologous elements in a 55/F presenting with postmenopausal bleeding. As it commonly simulates clinically and radiologically as benign cervical polyp, the gynecologists and pathologists should be aware of this extremely rare entity presenting with aggressive clinical course.

Well-differentiated liposarcoma of the breast arising in a background of malignant phyllodes tumor in a pregnant woman: A rare case report and review of literature

Pure mesenchymal sarcomas and phyllodes tumor with sarcomatous differentiation of the breast are rare tumors. Primary breast sarcomas are a heterogenous group of neoplasms which include malignant fibrous histiocytoma, fibrosarcoma, angiosarcoma, leiomyosarcoma, osteosarcoma, rhabdomyosarcoma, and liposarcoma. Sarcomatous differentiation in phyllodes tumor is seen in the form of angiosarcoma, chondrosarcoma, leiomyosarcoma, osteosarcoma, rhabdomyosarcoma, and liposarcoma. Here, we report a case of a 28-year-old pregnant woman with a breast lump during her second trimester which drastically increased in size in the postpartum period. Wide local excision revealed a malignant phyllodes tumor with liposarcomatous differentiation. Later, the patient underwent completion mastectomy which showed residual tumor.

Leiomioma vaginal de crecimiento rápido. Reporte de un caso / Rapidly growing vaginal leiomyoma. A case report

Resumen Antecedentes: Los leiomiomas vaginales son tumores poco frecuentes. Hasta la fecha solo se han reportado 330 casos en la bibliografía internacional. Caso clínico: Paciente de 37 años, que acudió al servicio médico por percibir una tumoración de crecimiento rápido en la vagina. A la exploración física se objetivó una masa de consistencia dura, no dolorosa a la palpación, de aproximadamente 30 mm de diámetro medio, ubicada en el tercio inferior de la cara lateral derecha de la vagina, compatible con mioma vaginal. En ese momento la paciente se negó a recibir tratamiento. Después de algunos meses acudió, nuevamente, a consulta debido a molestias vaginales, metrorragias mayores al ciclo menstrual y dispareunia. La ecografía y resonancia magnética mostraron una tumoración de gran tamaño (58 x 57 x 60 mm), redondeada y de aspecto sólido, situada en el espacio vesicovaginal. Con estos datos se estableció el diagnóstico de leiomioma vaginal pediculado. Para disminuir el volumen y sangrado de los miomas se le prescribieron 5 mg al día de acetato de ulipristal. Después de dos ciclos de tratamiento se objetivó un incremento de la tumoración, que alcanzó 70 x 55 mm. Se decidió efectuar la miomectomía por vía vaginal, sin advertir claramente el pedículo dependiente del útero y el cuello uterino. El posoperatorio trascurrió sin contratiempos. El estudio histopatológico confirmó el diagnóstico de leiomioma vaginal. Conclusión: Los signos y síntomas (sangrado o manchado anormal, secreción vaginal, dolor o masa pélvica) de los leiomiosarcomas extrauterinos dificultan de emitir recomendaciones precisas para establecer el diagnóstico y tratamiento.

Abstract Background: Vaginal leiomyomas are exceptional tumours. Only 330 cases have been reported in the world literature. Clinical case: Patient of 37 years old, with a vagina tumour of rapid growth. The physical examination showed a mass of hard consistency, without pain on palpation, of approximately 30 mm in average diameter, in the lower third of the right lateral of the vagina, compatible with the vaginal myoma. At that time the patient refused to receive treatment. After a few months, a consultation for vaginal discomfort, metrorragia greater than the menstrual cycle and dyspareunia. Ultrasonography and magnetic resonance showed a tumour that increased in size (58 x 57 x 60 mm), had a rounded shape and a solid appearance, located in the vesicovaginal space. With these data the diagnosis of pediculated vaginal leiomyoma was established. Ulipristal acetate (5 mg / day) was prescribed to decrease volume and myomatous bleeding. After two treatment cycles, an increase in the tumour was observed, which reached a size of 70 x 55 mm. It was decided to perform myomectomy vaginally, without objectifying the pedicle dependent on the uterus and the cervix. The postoperative period was uneventful. The histopathological study confirms the diagnosis of vaginal leiomyoma. Conclusion: The signs and symptoms (bleeding or abnormal staining, vaginal discharge, pain or pelvic mass) of the extrauterine leiomyosarcomas make it difficult to establish precise recommendations to establish the diagnosis and treatment.

Clinicopathologic study of adenosarcoma with sarcomatous overgrowth of the uterine / 临床与实验病理学杂志

Purpose To investigate the clinicopathologic characteristtics, immunophenotype and differential diagnosis of uterine adenosarcoma with sarcomatous overgrowth. Metheds The clinicopathological data of 4 cases of uterine adenosarcoma with sarcomatous overgrowth were collected, the histopathologic and immunohistochemical features were investigated, and the rele-vant literatures were also reviewed. Results All of tumors were arised from the endometrium with complains of postmenopausal vaginal bleeding or prolonged menstrual period. There is a poly-poid nodular in the uterine cavity with a pedicle or no pedicel, or rough endometrium. On the cut surface, the tumor was fish-like without distinct from the surrounding tissue. Light microsco-py show the tumors were composed of benign glands and malignant mesenchymal components, the sarcomatouscomponents ac-counted for over 25％. In 4 cases, 2 cases had heterologous com-ponent of rhabdomyosarcoma. The component of sarcomatous were positive for vimentin and CD10. The heterologous component of rhabdomyosarcoma were positive for desmin, MyoDl, and Myogenin.3 cases were died at in 5, 10, and 19 months after operation, 1 patient was disease free survival for 3 months. Conclusion Uterine adenosarcoma with sarcomatous overgrowth has a bad prognosis.

Gliosarcoma of Cerebello-Pontine Angle: A Case Report and Review of the Literature

Gliosarcoma (GS), known as variant of glioblastoma multiforme, is aggressive and very rare primary central nervous system malignant neoplasm. They are usually located in the supratentorial area with possible direct dural invasion or only reactive dural thickening. However, in this case, GS was located in lateral side of left posterior cranial fossa. A 78-year-old man was admitted to our hospital with 3 month history of continuous dizziness and gait disturbance without past medical history. A gadolinium-enhanced MRI demonstrated 5.6×4.8×3.2 cm sized mass lesion in left posterior cranial fossa, heterogeneously enhanced. The patient underwent left retrosigmoid craniotomy with navigation system. The tumor was combined with 2 components, whitish firm mass and gray colored soft & suckable mass. On pathologic report, the final diagnosis was GS of WHO grade IV. In spite of successful gross total resection of tumor, we were no longer able to treat because of the patient's rejection of adjuvant treatment. The patient survived for nine months without receiving any special treatment from the hospital.

Malignant transformation in monostotic fibrous dysplasia:clinical and imaging features / 实用放射学杂志

Objective To investigate clinical and imaging features of malignant transformation in monostotic fibrous dysplasia (FD).Methods Radiography (n=12),computed tomography (CT)(n=7)and magnetic resonance imaging (MRI)(n=5)data of 12 monostotic FD cases proved by surgery and pathology were retrospectively reviewed.Results Among 12 cases,6 cases underwent surgery.Their images showed osteolytic lesions in the operative area with direct signs of aggressiveness (poorly defined margin,cor-tical destruction and soft tissue mass).For the 6 cases without surgery,radiography and CT showed poorly margin,osteolytic le-sions within or near the area of ground-glass opacity.MRI showed lesions with heterogeneous signal intensity and pronounced con-trast-enhancement.Histopathologically,9 cases were osteosarcomas,2 cases were fibrosarcomas,and 1 case was malignant fibrous histiocytoma (MFH).Conclusion The imaging information of malignant transformation of FD can provide evidence of possible ma-lignancy.

Image Findings of Sarcomatous Intrahepatic Cholangiocarcinoma Focused on Gd-EOB-DTPA Enhanced MRI: A Case Report

Sarcomatous Intrahepatic cholangiocarcinoma is a rare but an aggressive variant of cholangiocarcinoma with a very poor prognosis. A 79-year-old man was admitted to our hospital because of incidentally found liver mass. Magnetic resonance imaging (MRI) revealed well-defined hypointense mass on T1WI and heterogeneous hyperintense mass on T2WI. Gd-EOB-DTPA enhanced study shows peripheral rim-like enhancement in arterial phase and progressive concentric filling of contrast in delayed phase. And mass shows significant enhancement in hepatobiliary phase. The pathologic diagnosis was intrahepatic cholangiocarcinoma with sarcomatous change.

Carcinosarcoma of oesophagus: A case report.

Oesophageal carcinosarcoma is a rare type of oesophageal cancer composed of both epithelial and mesenchymal components, occuring with an incidence of about 0.1-1.5 % of all oesophageal tumors. Most of the cases have been reported from Japan. Very few cases have been reported from India. We report a case of 65 year old female who presented with dysphagia and weight loss. Endoscopy revealed a bulky mass and the preliminary diagnosis was oesophageal carcinoma. On histology of the surgical specimen, the tumour revealed both epithelial and sarcomatous malignant cells. A tentative diagnosis of oesophageal carcinosarcoma was made. Immunohistochemical studies showed positivity for both pancytokeratin and vimentin thus confirming the diagnosis.

Linfoma ósseo primário simultâneo a osteocondroma simulando degeneração sarcomatosa: relato de caso / Primary bone lymphoma simultaneous to osteochondroma simulating sarcomatous degeneration: case report

Não há evidências relatadas na literatura de associação entre linfoma ósseo primário e osteocondroma ou da coexistência deles em uma mesma região óssea. Este relato de caso descreve um caso raro de linfoma ósseo primário ocorrendo juntamente com um osteocondroma no terço proximal de tíbia. Os sinais de imagem na ressonância magnética neste caso simulam uma degeneração sarcomatosa do osteocondroma.

In the literature, there is no evidence of relationship between primary bone lymphoma and osteochondroma or of coexistence of both of them in a single bone. The present report describes an uncommon case of primary bone lymphoma occurring simultaneously with osteochondroma in the proximal third of the tibia. In the present case, magnetic resonance imaging signs simulated the presence of sarcomatous degeneration.

Diagnóstico ecográfico de mioma uterino en mujeres con síntomas ginecológicos / Ultrasound diagnosis of uterine myoma in women with gynecological symptoms

Se realizó un estudio descriptivo y transversal de 76 pacientes atendidas en el Departamento de Ultrasonido del Hospital "Carlos Manuel de Céspedes" de Bayamo, Granma, desde junio de 2011 hasta enero de 2012, con vistas a describir las características ecográficas del mioma uterino en mujeres con síntomas ginecológicos. Entre las variables analizadas figuraron: edad, color de la piel, hallazgos ecográficos y correspondencia entre el diagnostico presuntivo y el ecográfico. En la serie prevalecieron las diagnosticadas con mioma uterino, el grupo etario de 15-45 años y las féminas de piel negra. Asimismo, predominaron los miomas múltiples y de localización intramural. Las complicaciones que primaron fueron la degeneración quística y las calcificaciones. No hubo total correspondencia entre las indicaciones médicas presuntivas de miomas y el diagnóstico ecográfico definitivo.

A descriptive and cross-sectional study was conducted in 76 patients attended in the Ultrasound Department of "Carlos Manuel de Céspedes" Hospital in Bayamo, Granma, from June 2011 to January 2012, in order to describe the sonographic characteristics of the uterine myoma in women with gynecological symptoms. Among the analyzed variables were age, race, sonographic findings and correspondence between the presumptive and sonographic diagnosis. Those diagnosed with uterine myoma, age group of 15-45 years and black women prevailed in the series. Also, multiple myomas and those of intramural location prevailed. Cystic degeneration and calcifications were the prevailing complications. There was not total correspondence between the presumptive medical indications of myomas and the final ultrasound diagnosis.

Huge subcapsular hematoma caused by intrahepatic sarcomatoid cholangiocarcinoma

Intrahepatic sarcomatoid cholangiocarcinomais is a very rare disease with a poor prognosis due to its biologically aggressive tumor behavior. We report a patient who presented with subcapsular hemorrhage and a rapidly growing liver mass. A 57 year-old man was admitted with severe abdominal pain. CT and MRI images showed the presence of a 10 cm-sized subcapsular hemorrhage connected with a multi-lobulated mass with hemorrhage and necrotic foci in the right liver. The patients underwent right hemihepatectomy with caudate lobectomy and lymphadenectomy. The operation findings revealed metastatic nodules to the diaphragm and omentum. Detailed histopathological analysis through immunohistochemistry confirmed the diagnosis of sarcomatoid cholangiocarcinoma with a poorly undifferentiated sarcomatous component. The patient underwent chemotherapy. To date, the patient is doing well for 8 months after initial diagnosis.

Reporte de caso clínico: hemangioendotelioma esplénico de células epitelioide. Primer reporte latinoamericano / Clinical case report: splenic hemangioendothelioma of epithelioid cells

El Hemangioendotelioma esplénico es una rara neoplasia sarcomatosa de etiología idiopática y malignidad intermedia, entre el hemangioma y el hemangioendoteliosarcoma. Se presenta el caso de un paciente de sexo masculino de 54 años que acude a consulta por presentar dolor postraumático y una masa tumoral esplénica palpable. Diagnóstico prequirúrgico compatible con una lesión quística vascular. Histológicamente está compuesto por células redondas atípicas epitelioides con núcleos grandes y nucléolos prominentes, acompañado por proliferación de canales vasculares y, en ciertas áreas, con células fusiformes elongadas. En estudio de inmunohistoquímica se muestra células tumorales positivas para el antígeno CD34 (FLEX 2x5 DAB) y anticuerpos de vimentina. El componente estromal muestra evidente diferenciación miofibroblástica. A pesar de tratarse de una patología sumamente infrecuente (solo siete casos reportados a nivel mundial) posee un buen pronóstico y no se han documentado recidivas. Se han descrito tres variantes histopatológicas: epitelioide, kaposiforme y retiforme. Se realiza el diagnóstico diferencial con el tipo kaposiforme por cuanto es evidente la ausencia de luces vasculares en media luna, así como los respectivos depósitos de hemosiderina y se descarta angiosarcoma al no observarse células anaplásicas.

The splenic hemangioendothelioma is a rare sarcomatous neoplasm of idiopathic etiology and intermediate malignancy, between hemangioma and hemangioendothelioma. This is the case of a 54-year-old male patient who goes to the doctor with post-traumatic pain disorder and a palpable splenic tumor. The preoperative diagnosis was compatible with a vascular cystic lesion. Histologically, it is composed of atypical epithelioid round cells with large nuclei and prominent nucleoli, accompanied by a proliferation of vascular channels and, in some areas, by elongated spindle cells. An immunohistochemistry study shows tumor cells that are positive for the CD34 antigen (FLEX 2x5 DAB) and Vimentin antibodies. The stromal component clearly shows myofibroblastic differentiation. Despite being a extremely rare disease (only seven cases reported worldwide) it has a good prognosis and recurrence has not been documented. Three histopathological variants have been described: epithelioid, kaposiform and retiform. A differential diagnosis is made with the kaposiform type because of the evident absence of “half-moon” vascular lumina, as well as the respective reservoirs of hemosiderin; angiosarcoma is ruled out because of the absence of anaplastic cells.

Mullerian adenosarcoma (heterologous) of the cervix with sarcomatous overgrowth: a case report with review of literature / 부인종양

Mullerian adenosarcoma is a rare biphasic malignant neoplasm of the cervix characterized by an admixture of benign epithelial elements and a malignant sarcomatous stromal component, which may be either homologous or heterologous. An aggressive variant of adenosarcoma, mullerian adenosarcoma with sarcomatous overgrowth (MASO) is extremely rare, with only two such cases being reported in the English literature to date. In this report we present a case of MASO of uterine cervix with heterologous elements in a 15-year-old unmarried girl presenting with foul smelling menstrual bleeding and passage of fleshy masses. Because MASO with heterologous elements seems to appear at the earliest stages of reproductive lifespan in women, and have an uncertain malignant potential, gynecologists and pathologists should be aware and think about the possibility of this tumor.

Degeneração sarcomatosa de doença de Paget do calcâneo: relato de caso / Sarcomatous degeneration of Paget's disease in the calcaneus: a case report

A degeneração maligna das lesões da doença de Paget é rara (cerca de 1% dos casos), sendo de mau prognóstico apesar do tratamento. Relatamos o caso de um paciente de 82 anos de idade, portador de doença de Paget há vários anos, em que se identificaram, nos exames de imagem, características de degeneração maligna no calcâneo, com anatomopatológico evidenciando degeneração sarcomatosa do osso.

Neoplastic degeneration in Paget's disease is a rare complication (approximately 1% of cases) and, despite the treatment, presents a poor prognosis. The authors report a case of a male, 82-year-old patient with long standing Paget's disease who presented imaging findings of malignant degeneration in the calcaneus histopathologically diagnosed as sarcomatous degeneration.

Sarcomatous hepatocellular carcinoma: Two case reports and a review of Korean clinical literature / 대한내과학회지

Sarcomatous hepatocellular carcinoma (HCC) is a rare primary liver cancer. Pathogenesis of sarcomatous transformation of HCC has not yet been elucidated. Sarcomatous HCC has highly invasive and metastatic potential, compared with ordinary HCC. We present here two cases of sarcomatous hepatocellular carcinoma with an unfavorable prognosis. Other cases reported in Korean literature of this uncommon tumor were also reviewed.

Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma

PURPOSE: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis after hepatic resection have yet to be clarified. The purpose of this study was to analyze the outcome of sarcomatous HCC patients who underwent surgical resection. METHODS: From January 1997 to May 2005, 11 patients (1.1%) were diagnosed with sarcomatous HCC among 1,005 cases of HCC undergoing resection after pathology and immunohistochemical studies. RESULTS: All of the cases were male and their mean age was 55.8+/-8.1 years. R0 resection was achieved in nine of the 11 patients. The HCC lesions were classified as stage II in three, stage III in four, stage IVa2 in three, and IVb in one, according to the modified pTNM staging system. Extrahepatic metastases as the initial recurrence occurred in eight patients. Among the 11 patients, 10 died of a disease recurrence and only one is still alive. The overall 3-year survival rate was only 18%. CONCLUSIONS: The prognosis of sarcomatous HCC was very poor, showing widespread extrahepatic metastases and frequent early recurrence regardless of the tumor extent. Since some patients showed prolonged survival after a local recurrence, vigorous postoperative systemic surveillance appears to be beneficial for early detection and timely treatment of localized metastases.

Sarcoma and Sarcomatous Metaplastic Carcinoma of the Breast / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Primary sarcoma and SMC (sarcomatous metaplastic carcinoma) of the breast are very rare tumors, accounting for less than 1% of all breast malignancies. There are many controversies concerning the biological characteristics, prognosis and optimal treatment of these tumors owing to the rarity of incidence. The aims of this study were to elucidate the clinicopathologic characteristics of these tumors and to assist in elucidating the optimal treatment plan for the disease. MATERIALS AND METHODS: 13 cases of primary sarcoma and 10 cases of SMC that had been treated at KCCH between 1984 and 2001 were retrospectively reviewed. Phyllodes tumors were excluded from our study. RESULTS: Among the 13 cases of primary sarcoma included, stromal sarcoma occurred in 5 cases, osteosarcoma in 3 cases, angiosarcoma in 3 cases and spindle cell sarcoma in 2 cases. The mean age of the patients with primary sarcoma and SMC was 39.7 years and 55.1 years respectively (p=0.002). When survival rates were compared according to histologic types, size of tumor, histologic grade, type of surgery and use of adjuvant therapy, both size of tumor (p=0.0256) and histologic grade (p=0.0197) were shown to be prognostic factors. CONCLUSION: There were no significantly different features between primary sarcoma and SMC in terms of biologic characteristics or survival rates, with the exception that patients with SMC were older than those with primary sarcoma. Histologic grade and size of tumor were significant prognostic factors of these tumors.

Hepatocellular Carcinoma of the Liver with Sarcomatous Feature / 한국간담췌외과학회지

One case of hepatocellular carcinoma with sarcomatous changes is presented. Histologically, the tumor was composed of hepatocellular-carcinomatous and sarcomatous components, including trabecular, pseudoglandular, and spindle-shaped varieties. There was a transitional cell form between the carcinoma and sarcomatous cells. Immunohistochemical examination for alpha-feto protein reveals positive staining in hepatocellular carcinoma component, and vimentin had positive result in most spindle-shaped sarcomatous cells and some epithelial tumor cells, whereas cytokeratin and EMA(epithelial membrane antigen) revealed negative staining in tumor cells, On the basis of this findings, the possibility of sarcomatous transformation of hepatocellular carcinoma was discussed.