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Objective: By analyzing the clinical characteristics, treatment options, and prognosis of different stages of sarcomatoid hepatocellular carcinoma (SHC), this study aimed to improve clinicians' understanding of SHC. Methods: The clinical data of 24 patients with SHC between January 2015 and December 2019 from First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 16 men and 8 women with a median age of 55 years. Results: The clinical symptoms were mainly abdominal pain and fever; 66.7% of the patients had hepatitis virus infection and 79.2% had liver cirrhosis. Patients with stage III- carcinoma accounted for 87.5% of the study population. The mean largest tumor diameter was 6.27cm. Patients who were followed up were treated at our hospital, of which one patient underwent liver transplantation, eight underwent surgery, three received locoregional therapy only, and the rest received best support care, chemotherapy, or targeted or combined immunotherapy. Computed tomography or magnetic resonance imaging showed abnormal findings, and biopsy or postoperative pathology was consistent with SHC. The median follow-up period was 4.8(1-39.7) months, and the median overall and disease-free survival of postoperative patients was 4.7 and 2.3 months, respectively. The median overall survival (OS) was 4.8 months for patients with stage III- carcinoma. Conclusions: For patients with stage I SHC, surgical resection is the preferred treatment. Postoperative adjuvant therapy can benefit patients. For patients with stage III- SHC, the benefits of surgery are limited. Systemic chemotherapy, oral targeted drug treatment, or local therapy is feasible for reducing the tumor burden. However, the prognosis of patients with SHC is generally poor, regardless of stage or therapeutic methods. Chemotherapy combined with targeted drugs and immunotherapy may become a new therapeutic direction for advanced SHC.
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Objective To study the clinicopathological features of sarcomatoid hepatocellular carcinoma (SHC).Methods The clinical data of 42 patients with SHC who underwent surgical resection in the Peking University People's Hospital (n =33) and the Department of Pathology of the Peking University Health Science Center (n=9) from January 2008 to May 2017 were retrospectively analyzed.Results The average age was 58.3 (aged 32～84) years;the ratio of male to female was 2.2 ∶ 1;the average diameter of the lesions was 8.2 cm;the median AFP value was 45.2 ng/ml.The median survival time was 10.5 months,the average progression-free survival time was 2.9 months,and the 5-year survival rate was 25.0％.On histopathology,the tumor consisted of various degrees of different differentiated carcinomas with aligned sarcomatoid spindle cells.Immunohistochemical results in the sarcomatoid region expressed both mesenchymal markers and epithelial-derived markers.Conclusions SHC tumors were highly aggressive,with high rates of lymph node metastasis and poor prognosis.The diagnosis of SHC mainly depended on histopathology.Immunohistochemistry was very important for its diagnosis and differential diagnosis.Surgical resection was the treatment modality of choice to achieve prolonged survival time.
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Objective To explore the characteristics of contrast-enhanced ultrasonagraphy(CEUS) of sarcomatoid hepatocellular carcinoma ( SHC ) . Methods Fifteen lesions identified pathologically from 15 patients were included in this study . Among them ,9 lesions had completely sarcomatoid change and 6 lesions had partially sarcomatoid change . Totally 8 lesions were in the small size group with maximum diameter＜ 50 mm and 7 lesions in the big size group with maximum diameter ≥ 50 mm . The CEUS performance was observed and analyzed . Results In the arterial phase of CEUS ,9 lesions in the group with completely sarcomatoid change showed rim hyperenhancement and 6 lesions in the group with partially sarcomatoid change showed whole hyperenhancement , the difference between the two groups was statistically significant ( P ＜ 0 .001 ) . However ,the difference of CEUS performance between small size group and big size group was not statistically significant ( P ＝ 0 .608 ) , all the lesions showed hypoechogenecity in portal and(or) late phase of CEUS . Conclusions The difference of performance on CEUS is not related to the size of SHC ,but to the degree of sarcomatoid change within the tumor . SHC with completely sarcomatoid change shows rim hyperenhancement and SHC with partially sarcomatoid change shows entire hyperenhancement in arterial phase on CEUS .
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Objective:To discusse the clinical features of sarcomatoid hepatocellular carcinoma to improve the understanding of diagnosis and treatment for sarcomatoid hepatocellular carcinoma. Methods:Data including clinical features and follow-up from 8 pa-tients admitted in Tianjin Medical University Cancer Institute and Hospital from January 2009 to April 2014 were retrospectively ana-lyzed. Results: The average age of all patients was 56.6 years old, and the male-to-female ratio was 3:1. Preoperative CT or MRI showed specific characteristics but it was difficult to confirm diagnosis. Pathological and immunohistochemical examination revealed an expressed epithelial-like phenotype. All 8 patients had advanced local tumor invasion and high lymph node metastasis rates. These patients received surgery, and the median survival time was 10.8 months (3 months to 35 months). Conclusion:Diagnosis of sarcoma-toid hepatocellular carcinoma mainly depended on postoperative pathological examination. Immunohistochemistry was beneficial for sarcomatoid hepatocellular carcinoma diagnosis and differential diagnosis. Surgical treatment prolonged survival time, but the overall prognosis remained poor.
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PURPOSE: Sarcomatoid hepatocellular carcinoma (HCC) is a rare neoplasm and it has been found in only 1.8% of the surgically resected HCC patients, and in only 3.4~9.4% of the autopsied HCC cases. The pathogenesis of this tumor has't yet been thoroughly clarified, and such a tumor has been variously referred to as spindle cell carcinoma, sarcomatoid carcinoma, pseudosarcoma, or carcinosarcoma. There is only a little difference between the clinical characteristics of the sarcomatoid HCC and those of ordinary HCC. The diagnosis of the sarcomatoid HCC is made by pathological and immunohistochemical techniques after surgical resection, biopsy, or autopsy. METHODS: We reviewed the 10 cases of pathologically confirmed sarcomatoid HCC that were registered at the Yonsei University Medical Center from 1992 to 2004. RESULTS: Surgical operation was performed in seven cases, and curative resection was done only in five. Three patients were treated with chemotherapy or transarterial chemoem-bolization (TACE) with or without concurrent radiotherapy after the diagnosis of sarcomatoid HCC by liver biopsy. Six patients expired within 4 months after the diagnosis. The 6 month and 12 month survival rates for sarcomatoid HCC were 40% and 20%, respectively. The 6 month survival rates for radical resection and non-radical resection were 60% and 0%, respectively. The difference in cumulative survival according to the treatment of sarcomatoid HCC was statistically significant. CONCLUSION: The prognosis of sarcomatoid HCC is very poor; therefore, curative resection, adjuvant chemoradiotherapy, and close follow-up are necessary for patients suffering with sarcomatoid HCC.