title: Hepatic carcinosarcoma with heterogeneous carcinomatous and sarcomatous elements: report of a case and review of the literature.
abstract: We report a rare case of hepatic carcinosarcoma consisting of two carcinomatous components and four sarcomatous components. A 54-year-old Japanese man presented with sudden right upper abdominal pain. Computed tomography showed a hepatic tumor measuring 17 cm in the greatest dimension and intractable ascites, suggesting rupture of hepatocellular carcinoma (HCC). Transcatheter arterial embolization was repeated at our hospital, resulting in stabilization of the patient's general condition. Right anterior and left median sectionectomies were performed. Histologically, the tumor consisted of carcinomatous and sarcomatous elements. The carcinomatous elements consisted of moderately differentiated HCC (positive for hepatocyte antibody, murine monoclonal anti-cytokeratin antibody, and alpha-fetoprotein and negative for S-100 and desmin) and adenocarcinoma (negative for cytokeratin 7 and positive for carcinoembryonic antigen). Sarcomatous elements consisted of undifferentiated spindle cell sarcoma, rhabdomyosarcoma with acidophil striated cells including striped cells (desmin-positive), chondrosarcoma with cartilage matrix (S-100-positive), and osteosarcoma with osteoid. The sarcomatous elements were negative for epithelial markers. The patient is alive at 34 months after the operation with peritoneal dissemination. A total of 23 cases, including the present case, of hepatic carcinosarcoma have been reported in the English language literature. This is the third reported case of hepatic carcinosarcoma with heterogeneous carcinomatous and sarcomatous elements.
authors.affiliation: Second Department of Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, Japan. thiroes@trad.ocn.ne.jp.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tazawa
authors.affiliation: Second Department of Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Itamoto
authors.affiliation: Second Department of Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oshita
authors.affiliation: Second Department of Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Second Department of Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Amano
authors.affiliation: Second Department of Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.affiliation: Second Department of Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
authors.affiliation: Programs for Biomedical Research, Division of Frontier Medical Science, Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University School of Medicine, Hiroshima, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Programs for Biomedical Research, Division of Frontier Medical Science, Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University School of Medicine, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
authors.affiliation: Central Clinical Division of Anatomical Pathology, Hiroshima University School of Medicine, Hiroshima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nakashima
keywords: Chondrosarcoma; HCC; Hepatic carcinosarcoma; Osteosarcoma; Rhabdomyosarcoma