Sarcomatoid carcinoma of renal pelvis: a case report / 中华泌尿外科杂志

Sarcomatoid carcinoma of the renal pelvis is rare. One case of sarcomatoid carcinoma of the left renal pelvis was reported. The patient was diagnosed as sarcomatoid carcinoma of left pyelonephrosis by left percutaneous nephrolithotripsy (PCNL) and biopsy of left pyelonephrosis in another hospital due to left lumbar pain.The patient came to our hospital for laparoscopic left hemiculturectomy and was pathologically diagnosed as left renal pelvic sarcomatoid carcinoma. The patient suffered left retroperitoneal recurrence and bilateral lung metastasis 7 months after surgery and died of cachexia 10 months later.

High grade spindle cell carcinoma of the ovary arising in an endometrioid cystadenoma: A case report

@#Spindle Cell Carcinoma of the Ovary is arate form of cancer with controversial histogenesis. It shares the histologic, cytologic, and molecular properties of both epithelial and mesenchymal differentiation of ovarian neoplasms, which makes diagnosis very challenging among pathologists. Endometrioid cystadenoma is a benign ovarian neoplasms classified under epithelial ovarian tumors.Malignant transformation of benign ovarian neoplasms is known as a rare complication, occurring in approximately 0.9% of patients with ovarian endometriosis. Clear cell adenocarcinoma is the most common endometriosis-associated ovarian cancer followed by endometrioid cancer. This is the case of a 56-year old post-menopausal patient initially presenting with increasingabdominal girth. Whole abdominal ultrasound revealed a large pelvo-abdominal mass. Transvaginal and transabdominal ultrasound findings of bilateral ovarian new growth with benign sonologic features. The patient underwent bilateral salpingo-oophorectomy. Histopathologic findings of the specimen submitted revealed high-grade spindle cell carcinoma arising in an endometrioid cystadenoma of the right ovary, and endometrioid cystadenofibroma with focal epithelial proliferation.

Carcinoma epidermoide sarcomatoso metastásico a la placenta: un reporte de caso / Metastatic sarcomatosus squamous carcinoma to the placenta: a case report

Resumen ANTECEDENTES: El cáncer epidermoide cutáneo de tipo sarcomatoide es una neoplasia rara, de bajo riesgo de malignidad, con menos del 2% de riesgo de metástasis. Su comportamiento agresivo es inusual y casi siempre asociado con factores que favorecen su malignidad. La metástasis a la placenta es también excepcional: hasta la actualidad solo se han reportado 61 casos. CASO CLÍNICO: Paciente de 35 años con antecedentes de dos embarazos, en curso de las 33 semanas de gestación, carcinoma epidermoide infiltrante en la pierna izquierda, con amputación supracondílea y metástasis pulmonar. Ingresó a urgencias por dificultad respiratoria, sin trabajo de parto, taquicárdica y taquipneica. Se decidió la cesárea con obtención de nacido vivo, de sexo femenino, 1860 g, sin complicaciones. Luego de la intervención, la paciente fue trasladada a una institución especializada en atención oncológica, donde falleció a las 24 horas. La recién nacida se dio de alta sin complicaciones y sin manifestaciones oncológicas o de otro tipo hasta el año de nacida. CONCLUSIONES: Luego de una búsqueda exhaustiva en la bibliografía los autores consideran que el caso aquí comunicado es el primero en Perú de cáncer epidermoide cutáneo de tipo sarcomatoide con metástasis a la placenta.

Abstract BACKGROUND: Sarcomatoid cutaneous epidermoid cancer is a rare neoplasm, with a low risk of malignancy and less than 2% risk of metastasis. Its aggressive behavior is unusual and almost always associated with factors favoring its malignancy. Placental metastasis is also exceptional: only 61 cases have been reported to date. CLINICAL CASE: 35-year-old female patient, with a history of two pregnancies, in 33 weeks of gestation, infiltrating squamous cell carcinoma of the left leg, with supracondylar amputation and pulmonary metastasis. She was admitted to the emergency room for respiratory distress, without labor, tachycardic and tachypneic. It was decided to perform a cesarean section with live birth, female, 1860 g, without complications. After the intervention, the patient was transferred to an institution specialized in oncologic care, where she died 24 hours later. The newborn was discharged without complications and without oncologic or other manifestations up to one year of age. CONCLUSIONS: After an exhaustive search of the literature, the authors consider the case reported here to be the first case of sarcomatoid epidermoid skin cancer with metastasis to the placenta.

Spindle Cell Carcinoma: A Confirmatory Diagnostic Analysis by Immunohistochemical Studies

Introduction: WHO defines it as a ‘‘carcinoma within which there are some elements resembling a squamous cell carcinoma that are admixed with a spindle cell component. Spindle cell carcinoma is an uncommon poorly differentiated type of SCC com- prising up to 3% of SCC and it is also known as sarcomatoid carcinoma which is a rare biphasic malignant neoplasm. . Case Report: A 20 year old female patient complains of pain and growth in lower front teeth region since 3 months and gave a history of growth 2yrs back in the front teeth region for which she has been operated but it has recurred again. Discussion: The histological features mimicked other connective tissue sarcomas & spindle cell malignancies at light micro- scopic level. Hence, after undergoing immunohistochemistryA careful study based on clinical, radiological and histopathologi- cal and immunohistochemical examination was done and a final diagnosis of spindle cell carcinoma was given.

The research progress in the treatment of advanced sarcomatoid renal cell carcinoma / 中华泌尿外科杂志

Sarcomatoid renal cell carcinoma is a highly malignant tumor with sarcomatoid dedifferentiation, which has rapid progression, high mortality rate and poor prognosis. Studies have shown that cytoreductive surgery, chemotherapy or targeted therapy are not effective to patients with advanced sarcomatoid renal cell carcinoma. With the further study of pathogenesis and molecular biological characteristics of sarcomatoid renal cell carcinoma, it is found that the expression levels of PD-1 and PD-L1 in it are higher than those of other subtypes, so the combination of immune checkpoint inhibitors and immunotherapy combined with targeted therapy have become the first-line therapy. This article mainly reviews the latest treatments for advanced sarcomatoid renal cell carcinoma, including surgery, chemotherapy, targeted drugs, immunotherapy and so on.

A Survival Prediction Model of Pulmonary Sarcomatoid Carcinoma Based on SEER Database / 肿瘤防治研究

Objective To analyze the factors affecting the prognosis of patients with pulmonary sarcomatoid carcinoma (PSC) and construct a nomogram prediction model for the prognosis of PSC patients. Methods Based on the SEER database, 1671 patients diagnosed as PSC from 1988 to 2015 were collected and divided into modeling group and validation group according to the ratio of 7:3. Univariate and multivariate Cox regression analysis were performed in the modeling group to explore independent risk factors affecting the prognosis and construct a nomogram survival prediction model. The consistency index and calibration curve were used for verification in the modeling group and the test module respectively. Results Age, gender, histological type, TNM stage, tumor diameter > 50mm, surgery, radiotherapy and chemotherapy were independent factors that affected the prognosis of PSC patients. The nomogram prediction model was constructed and verified based on independent factors. The C indexes of the modeling group and the test model were 0.790 (95%CI: 0.776-0.804) and 0.781 (95%CI: 0.759-0.803), respectively. The calibration curves of the modeling group and the test model indicated that the predicted survival rate was basically the same as the actual survival rate. Conclusion The nomogram prediction model constructed based on the results of multivariate analysis can predict the prognosis of PSC patients, and has high accuracy and consistency.

Clinical analysis of 24 patients with sarcomatoid hepatocellular carcinoma / 中国肿瘤临床

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.

Squamous cell carcinoma with sarcomatous transformation of the penis

Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.

Utility of medical thoracoscopy in diagnosis and treatment of hemothorax due to carcinoma: A case report

Hemothorax cannot always be treated by thoracic surgeon. Rapidly improved interventional pulmonology broadens the application of medical thoracoscopy. We attempt to share our experiences of medical thoracoscopy for hemothorax and discuss the value of medical thoracoscopy in pleural diseases. We reported a 76-year-old male with hemothorax who was cured by medical thoracoscopy under local anesthesia together with argon plasma coagulation. Moreover, final pathological diagnosis was acquired as pleural sarcomatoid carcinoma. The unusual manifestation under medical thoracoscopy of such a relative rare disease was also described in this paper. The medical thoracoscopy could be used successfully for hemothorax instead of treating with surgeon, especially for those who cannot tolerate procedure of operation or surgical thoracoscopy

Complete response to radiation therapy for nasopharyngeal sarcomatoid carcinoma

Nasopharyngeal sarcomatoid carcinoma (SaCa) is extremely rare, and concurrent chemoradiation is the standard treatment for squamous cell-based nasopharyngeal cancer (NPC). This case report gives the first explanation of a nasopharyngeal SaCa patient treated with volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB), which is an excellent treatment modality that leads to complete response for locally advanced NPC. A 70-year-old male presented with nasal obstruction, epistaxis, and right neck node enlargements. Examination revealed an extensive tumor of nasopharyngeal tumor extending into the nasal cavity and right parapharyngeal space with bilateral lymphadenopathy on positron emission tomography (PET)–computed tomography images of focal hypermetabolic bone lesion in C4 body (stage T3N2M1). An excisional biopsy of nasopharyngeal wall mass showed a SaCa. He received concurrent chemoradiation which was VMAT and systemic chemotherapy (cisplatin 60 mg). A dose of 70 Gy was delivered to the planning target volume (PTV70) (gross tumor volume plus margin 3–5 mm) and PTV59.4(a wider margin around high-risk clinical target volume, including the clivus and neck nodes) all given in 33 fractions. Radiological examination such as magnetic resonance imaging (MRI) and PET images at the completion of external beam therapy revealed questionable residual disease. Follow-up MRI scans 4 weeks after radiotherapy revealed a complete tumor response. VMAT with SIB can be an effective treatment option for SaCa of the advanced nasopharynx.

A case of tonsil sarcomatoid carcinoma / 临床耳鼻咽喉头颈外科杂志

Summary@#Sarcomatoid carcinoma, a malignant tumor containing both epithelial-derived malignant cells and malignant mesenchymal cells. Microscopically, cancer cells and sarcoma cells migrate to each other, and CK and Vimentin are simultaneously expressed. A rare case of tonsillar sarcomatoid carcinoma is discussed in our department with dysphagia as the first symptom.

A case of tonsil sarcomatoid carcinoma / 临床耳鼻咽喉头颈外科杂志

Sarcomatoid carcinoma, a malignant tumor containing both epithelial-derived malignant cells and malignant mesenchymal cells. Microscopically, cancer cells and sarcoma cells migrate to each other, and CK and Vimentin are simultaneously expressed. A rare case of tonsillar sarcomatoid carcinoma is discussed in our department with dysphagia as the first symptom.

Spectrum of prostate gland lesions: a clinico-pathologic study in south-western Bihar, India

Background: Prostate gland is an endocrine dependent organ in males and age-related lesions involve it. Inflammation, benign nodular hyperplasia and tumours are the commonest to involve it worldwide. Occasionally some other pathological changes can also involve it. The study was carried out for the first time to know the spectrum and prevalence of prostate lesions which will be of help to the clinicians in this location.Methods: Retrospective study was carried out for a period of four years and out of surgical cases of males which underwent operative procedure, prostate cases were retrieved and in the department of pathology, haematoxylin and eosin stained slides were evaluated and diagnosed.Results: A total of 138 cases were included and five cases were excluded from this series. Benign nodular hyperplasia (73.9%) was the commonest finding followed by chronic prostatitis associated with hyperplasia (15.2%), atypical glandular hyperplasia (2.9%) and prostatic intraepithelial neoplasia (2.1%). Malignant tumours were 5.8% constituting adenocarcinoma prostate as the most common (62.5%). A case of hemangiopericytoma was also diagnosed.Conclusions: Benign nodular hyperplasia of prostate is the most common affliction among males starting at age 45 years. Early consultation and screening will be of immense value. Adenocarcinoma prostate may involve at age around 58 years.

Clinicopathological and immunohistochemical analysis of Sarcomatoid carcinoma of head and neck mucosal region: a retrospective analysis

Background: Sarcomatoid carcinoma is a biphasic tumour comprising both of malignant epithelial and mesenchymal elements derived monoclonally from same stem cells. These are unusual variants of squamous cell carcinoma and constitute less than 1% of the head and neck mucosal tumors. Only few studies have been published and needs more understanding to establish treatment guidelines. The aim of this study was to review the cases of carcinosarcoma arising from mucosal sites of head and neck and study their clinical, histological and Immunohistochemical features.Methods: Retrospective data and slides of histologically proven sarcomatoid carcinoma over a period of thirty -four months between January 2016 - October 2018 were retrieved and evaluated for various clinical and histopathological parameters.Results: Total of 22 cases were included in the study and the mean age of presentation was 58years with male: female ration 2:1. Most of the patients (81.8%) presented with a mass lesion of less than 6 months duration. The most common site was oral cavity (68.1%) followed by larynx (22.7%). Clinical stage was known in eleven cases. One case presented with pulmonary metastasis. Histopathologically, epithelial differentiation was identified in nine cases (41%) on morphology and in thirteen cases could be highlighted by cytokeratin positivity. The Mesenchymal component was arranged in sheets (63.7%) and fascicles (31.8%). Marked anaplasia and brisk mitosis wereseen in 54.5% and 19.3% respectively.  On immunohistochemistry all 22 cases were positive for Vimentin, twenty cases were positive for cytokeratin/EMA and aberrant mesenchymal markers were expressed in 10% of cases.  Follow up was available in eighteen cases out of which fourteen cases died within one year of diagnosis.Conclusions: Diagnosis of sarcomatoid carcinoma is challenging especially on small biopsy because of overlapping features with other spindle cell tumors. Understanding the clinicopathological features facilitates their diagnosis and effective clinical management.

Nasopharyngeal undifferentiated carcinoma with sarcomatoid features: Pitfalls in the immunohistochemistry

@#We present a case of an undifferentiated subtype of non-keratinizing squamous cell carcinoma (NK-SCC) with sarcomatoid features in the nasopharynx in a 69-year-old man who was difficult to diagnose due to spindle-shaped malignant cells. He was admitted because of a right nasal obstruction and right headache, and imaging revealed a heterogeneously enhanced irregularly shaped mass at the nasopharynx. Histopathologically, the tumour was partially organised, and the tumour cells were epithelioid or spindle-shaped. Initially, we erroneously diagnosed the tumour as an angiosarcoma owing to its false-negative immunoreaction for cytokeratins and a mistaken interpretation for CD31. After in situ hybridization for Epstein-Barr virus was positive, a consultation and additional immunostaining (including re-staining for cytokeratin with varying dilutions) were performed, and the diagnosis was revised to NK-SCC with sarcomatoid features. We believe that sarcomatoid features may be observed in nasopharyngeal carcinoma and in this case, immunostaining using various epithelial markers is necessary and careful attention should be paid to the interpretation of immunostaining.

CT characteristics of primary pulmonary sarcomatoid carcinoma / 中国医师进修杂志

Objective To investigate the CT characteristics of primary pulmonary sarcomatoid carcinoma (PSC). Methods CT characteristics of 14 cases with primary pulmonary saromatoid cacinoma confirmed by surgical pathology were analyzed retrospectively. Results Among the 14 cases, the clinical manifestations were chest pain and cough in 6 cases, cough with blood-stained sputum in 5 cases, chest tightness and asthma in 2 cases, and no symptoms in 1 case. All the 14 cases had solitary masses in the lung. Carcinoma of 7 cases located in the upper lobe of the right lung, and carcinoma of 1 case located in the inferior lobe of the right lung. Carcinoma of 3 cases was located in the upper lobe of the left lung, and 3 cases were found in the inferior lobe of the left lung. Eleven cases had peripheral tumors and 3 cases had central tumors. CT plain scan revealed an isodense mass. There were 12 cases with uneven mass density and necrosis, and 2 cases had uniform mass density. The smooth margin was identified in 7 masses, and ill-defined margin and lobulation was shown in 7 masses. Cavity was observed in 1 mass, and speckled calcification was seen in 1 mass. Pleural invasion and thickening was in 5 cases, pneumothorax occurred in 1 case, and there was 1 case of liver metastasis. Enhancement scan showed patchy or annular enhancement around the mass, and the central enhancement of the mass was not obvious or uneven patchy enhancement. Conclusions The CT characteristics of primary pulmonary sarcomatoid carcinoma are solitary masses in the lung, especially if the mass is located in the periphery of the upper lobe of the right lung with uneven density, and enhancement scan shows patchy or annular enhancement around the mass.

Sarcomatoid carcinoma of throat: A report of 5 cases and literature review / 吉林大学学报(医学版)

Objective, To investigate the clinical features, pathological features, treatment methods and prognosis of 5 patients with sarcomatoid carcinoma of throat. Methods, The clinical data of 5 patients with sarcomatoid carcinoma of throat confirmed by pathology were retrospectively analyzed, and the relevant literatures were reviewed. Results, Among 5 patients with sarcomatoid carciroma of throat, 4 patients were male and 1 patient was female, with the onset age from 55 to 77 years old. Among them, 3 patients had a long-term smoking history and 2 patients had a long-term drinking history. The chief complaints of the patients were pharyngeal pain, foreign body sensation in the pharynx, hoarseness and dyspnea, etc. All 5 patients underwent electronic laryngoscope examination, and 1 case presented cauliflower mass, while the other patients presented smooth mass. CT examination was performed in 2 patients, and the mass showed soft tissue density shadow without bone destruction. All 5 patients received surgical treatment, including 2 cases of adjuvant radiotherapy after operation and 1 case of chemotherapy after operation. The postoperative histopathological examination and immunohistochemical staining results showed that the diagnosis of 5 patients was sarcomatoid carcinoma. The postoperative follow-up time was 1-36 months, and the follow-up rate was 100%, among 5 patients, 1 case survived and 4 cases died. Conclusion: Sarcomatoid carcinoma of throat has no specifically clinical characteristics, and mainly present polypoid growth and is easy to be misdiagnosed. Its malignant degree is higher than that of squamous cell carcinoma, and it is easy to relapse and metastasis in the late stage. Its prognosis is poor, the diagnosis depends on the pathological examination, and surgical resection is preferred.

Clinical and molecular characteristics of pulmonary sarcomatoid carcinoma

BACKGROUND/AIMS: Pulmonary sarcomatoid carcinoma (PSC) is a poorly differentiated non-small cell lung cancer (NSCLC) that contains components of spindle or giant cells. Owing to its low prevalence, there are insufficient data regarding its clinical features, therapeutic strategies and prognosis. METHODS: The medical records of 26 patients diagnosed with PSC from January 2009 to June 2015 were reviewed and analyzed for clinicopathological characteristics, treatment modality, and outcomes. RESULTS: The median age was 69.5 years. Twenty-three patients (88%) were male. Twenty-four patients (92%) were smokers. The median time from symptom onset to diagnosis was one month. Eighteen patients (69%) were diagnosed at an advanced stage. Pleomorphic carcinoma was the most common subtype, and epidermal growth factor receptor (EGFR) mutation was positive in two of 11 patients. Among 13 patients tested for programmed death ligand 1 (PD-L1) immunohistochemistry assay, eight showed high expression of PD-L1. The median overall survival (OS) of all patients was 9.5 months. In total, 12 patients were treated with chemotherapy: nine with platinum-based doublet therapy, two with tyrosine kinase inhibitor, and one with docetaxel. Seven patients showed partial response or stable disease. The median OS and progression-free survival of patients who received chemotherapy were 8.7 and 2.8 months, respectively. CONCLUSIONS: PSC was more common in males, smokers, and the elderly, with worse prognosis than ordinary NSCLC; chemotherapy response was favorable, and EGFR mutation status and PD-L1 expression may offer more therapeutic options.

Clinicopathological analysis of 42 patients with sarcomatoid hepatocellular carcinoma / 中华肝胆外科杂志

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.

Analysis of the contrast-enhanced ultrasonic characteristics of sarcomatoid hepatocellular carcinoma / 中华超声影像学杂志

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 .