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Carcinosarcoma of the liver: a case report.

Kwon JH, Kang YN, Kang KJ - Korean J Radiol (2007 Jul-Aug)

Bottom Line: Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described.We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology.Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. kjh2603@dsmc.or.kr

ABSTRACT
Primary hepatic carcinosarcoma is a rare tumor comprised of a mixture of carcinomatous and sarcomatous elements. Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described. We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology. Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.

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Related in: MedlinePlus

A. Longitudinal ultrasonography through the left liver showed a lobulate heterogeneous echogenic solid mass (cursors) with a highly echogenic lesion (arrow) that had posterior acoustic shadowing within it.B-E. Computed tomographic scan of this mass revealed peripheral enhancing viable portions (white arrows), large internal non-enhancing necrotic portions (black arrows), and a dense radiopaque lesion (arrowhead). The enhancing portion of this mass is hypoattenuating in precontrast scan (B), hyperattenuating in arterial phase (C), hypoattenuating in portal phase (D), and isoattenuating in equilibrium phase (E).F-G. Upon magnetic resonance imaging this mass is hypointense on the T1-weighted image (F) and hyperintense on the T2-weighted image (G). On the T2-weighted images, peripheral viable portions (white arrows) are slightly hyperintense, necrotic portions (black arrows) are moderately hyperintense, and small cystic portions (black arrowheads) are very hyperintense. Calcification and ossification have low or dark signal intensity (white arrowheads) on T1- and T2-weighted images.H. A section of gross specimen showing a well-demarcated, dumbbell-shaped, multilobulate, grayish white, solid and firm mass with a central area of necrosis and hemorrhage, measuring 8.0 cm in its greatest dimension.I. The tumor mass was composed of diffusely proliferating spindle-shaped atypical cells and scattered epithelial cell clusters (Hematoxylin & Eosin staining, × 200).J. Large atypical pyknotic cells embedded in a hyaline chondroid matrix were detected mixed with adjacent anaplastic tubular epithelial clusters and anaplastic spindle cells (Hematoxylin & Eosin staining, × 200) (Inset). Calcification within the cartilage component was occasionally detected (Hematoxylin & Eosin staining, × 100).K. Transitional features of atypical spindle and epithelial cells are seen with an irregular anastomosing reddish osteoid matrix (Hematoxylin & Eosin staining, × 200).L. The epithelial component was positive for cytokeratin 7 and 19 (cholangiocytic differentiation markers), but negative for hepatocyte (hepatocytic differentiation marker). Atypical spindle cells and cartilaginous components (large arrow) were all positive for vimentin (mesenchymal differentiation marker), however the scattered epithelial clusters were negative for vimentin (small arrows).
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Figure 1: A. Longitudinal ultrasonography through the left liver showed a lobulate heterogeneous echogenic solid mass (cursors) with a highly echogenic lesion (arrow) that had posterior acoustic shadowing within it.B-E. Computed tomographic scan of this mass revealed peripheral enhancing viable portions (white arrows), large internal non-enhancing necrotic portions (black arrows), and a dense radiopaque lesion (arrowhead). The enhancing portion of this mass is hypoattenuating in precontrast scan (B), hyperattenuating in arterial phase (C), hypoattenuating in portal phase (D), and isoattenuating in equilibrium phase (E).F-G. Upon magnetic resonance imaging this mass is hypointense on the T1-weighted image (F) and hyperintense on the T2-weighted image (G). On the T2-weighted images, peripheral viable portions (white arrows) are slightly hyperintense, necrotic portions (black arrows) are moderately hyperintense, and small cystic portions (black arrowheads) are very hyperintense. Calcification and ossification have low or dark signal intensity (white arrowheads) on T1- and T2-weighted images.H. A section of gross specimen showing a well-demarcated, dumbbell-shaped, multilobulate, grayish white, solid and firm mass with a central area of necrosis and hemorrhage, measuring 8.0 cm in its greatest dimension.I. The tumor mass was composed of diffusely proliferating spindle-shaped atypical cells and scattered epithelial cell clusters (Hematoxylin & Eosin staining, × 200).J. Large atypical pyknotic cells embedded in a hyaline chondroid matrix were detected mixed with adjacent anaplastic tubular epithelial clusters and anaplastic spindle cells (Hematoxylin & Eosin staining, × 200) (Inset). Calcification within the cartilage component was occasionally detected (Hematoxylin & Eosin staining, × 100).K. Transitional features of atypical spindle and epithelial cells are seen with an irregular anastomosing reddish osteoid matrix (Hematoxylin & Eosin staining, × 200).L. The epithelial component was positive for cytokeratin 7 and 19 (cholangiocytic differentiation markers), but negative for hepatocyte (hepatocytic differentiation marker). Atypical spindle cells and cartilaginous components (large arrow) were all positive for vimentin (mesenchymal differentiation marker), however the scattered epithelial clusters were negative for vimentin (small arrows).

Mentions: A 46-year-old woman was referred after having general weakness for one month. Biochemical indices of liver function were normal. The tumor markers revealed the following: alpha-fetoprotein level, 2.1 ng/mL (< 9.6 ng/mL); carcinoembryonic antigen level, 1.5 ng/mL (< 5.0 ng/mL); serum carbohydrate antigen 19-9 level, 13.2 U/mL (< 39 U/mL). Serum markers for hepatitis B and C were negative. Ultrasonography showed a lobulate heterogeneous echogenic solid mass with a highly echogenic lesion with posterior acoustic shadowing within the mass in the left lobe of the liver (Fig. 1A). Computed tomographic analysis of the mass revealed peripheral enhancing viable portions, large internal non-enhancing necrotic portions, and a dense radiopaque lesion (Figs. 1B-E). The enhancing portion of this mass was hypoattenuating in the precontrast scan (Fig. 1B), hyperattenuating in the arterial phase (Fig. 1C), hypoattenuating in the portal phase (Fig. 1D), and isoattenuating in the equilibrium phase (Fig. 1E). Upon magnetic resonance imaging, this mass was observed to be hypointense on the T1-weighted image (Fig. 1F) and hyperintense on the T2-weighted image (Fig. 1G). On the T2-weighted images, peripheral viable portions were slightly hyperintense, internal necrotic portions were moderately hyperintense, and small central cystic portions were very hyperintense. Calcification and ossification had low or dark signal intensity on the T1- and T2-weighted images (Figs. 1F, G).


Carcinosarcoma of the liver: a case report.

Kwon JH, Kang YN, Kang KJ - Korean J Radiol (2007 Jul-Aug)

A. Longitudinal ultrasonography through the left liver showed a lobulate heterogeneous echogenic solid mass (cursors) with a highly echogenic lesion (arrow) that had posterior acoustic shadowing within it.B-E. Computed tomographic scan of this mass revealed peripheral enhancing viable portions (white arrows), large internal non-enhancing necrotic portions (black arrows), and a dense radiopaque lesion (arrowhead). The enhancing portion of this mass is hypoattenuating in precontrast scan (B), hyperattenuating in arterial phase (C), hypoattenuating in portal phase (D), and isoattenuating in equilibrium phase (E).F-G. Upon magnetic resonance imaging this mass is hypointense on the T1-weighted image (F) and hyperintense on the T2-weighted image (G). On the T2-weighted images, peripheral viable portions (white arrows) are slightly hyperintense, necrotic portions (black arrows) are moderately hyperintense, and small cystic portions (black arrowheads) are very hyperintense. Calcification and ossification have low or dark signal intensity (white arrowheads) on T1- and T2-weighted images.H. A section of gross specimen showing a well-demarcated, dumbbell-shaped, multilobulate, grayish white, solid and firm mass with a central area of necrosis and hemorrhage, measuring 8.0 cm in its greatest dimension.I. The tumor mass was composed of diffusely proliferating spindle-shaped atypical cells and scattered epithelial cell clusters (Hematoxylin & Eosin staining, × 200).J. Large atypical pyknotic cells embedded in a hyaline chondroid matrix were detected mixed with adjacent anaplastic tubular epithelial clusters and anaplastic spindle cells (Hematoxylin & Eosin staining, × 200) (Inset). Calcification within the cartilage component was occasionally detected (Hematoxylin & Eosin staining, × 100).K. Transitional features of atypical spindle and epithelial cells are seen with an irregular anastomosing reddish osteoid matrix (Hematoxylin & Eosin staining, × 200).L. The epithelial component was positive for cytokeratin 7 and 19 (cholangiocytic differentiation markers), but negative for hepatocyte (hepatocytic differentiation marker). Atypical spindle cells and cartilaginous components (large arrow) were all positive for vimentin (mesenchymal differentiation marker), however the scattered epithelial clusters were negative for vimentin (small arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
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Figure 1: A. Longitudinal ultrasonography through the left liver showed a lobulate heterogeneous echogenic solid mass (cursors) with a highly echogenic lesion (arrow) that had posterior acoustic shadowing within it.B-E. Computed tomographic scan of this mass revealed peripheral enhancing viable portions (white arrows), large internal non-enhancing necrotic portions (black arrows), and a dense radiopaque lesion (arrowhead). The enhancing portion of this mass is hypoattenuating in precontrast scan (B), hyperattenuating in arterial phase (C), hypoattenuating in portal phase (D), and isoattenuating in equilibrium phase (E).F-G. Upon magnetic resonance imaging this mass is hypointense on the T1-weighted image (F) and hyperintense on the T2-weighted image (G). On the T2-weighted images, peripheral viable portions (white arrows) are slightly hyperintense, necrotic portions (black arrows) are moderately hyperintense, and small cystic portions (black arrowheads) are very hyperintense. Calcification and ossification have low or dark signal intensity (white arrowheads) on T1- and T2-weighted images.H. A section of gross specimen showing a well-demarcated, dumbbell-shaped, multilobulate, grayish white, solid and firm mass with a central area of necrosis and hemorrhage, measuring 8.0 cm in its greatest dimension.I. The tumor mass was composed of diffusely proliferating spindle-shaped atypical cells and scattered epithelial cell clusters (Hematoxylin & Eosin staining, × 200).J. Large atypical pyknotic cells embedded in a hyaline chondroid matrix were detected mixed with adjacent anaplastic tubular epithelial clusters and anaplastic spindle cells (Hematoxylin & Eosin staining, × 200) (Inset). Calcification within the cartilage component was occasionally detected (Hematoxylin & Eosin staining, × 100).K. Transitional features of atypical spindle and epithelial cells are seen with an irregular anastomosing reddish osteoid matrix (Hematoxylin & Eosin staining, × 200).L. The epithelial component was positive for cytokeratin 7 and 19 (cholangiocytic differentiation markers), but negative for hepatocyte (hepatocytic differentiation marker). Atypical spindle cells and cartilaginous components (large arrow) were all positive for vimentin (mesenchymal differentiation marker), however the scattered epithelial clusters were negative for vimentin (small arrows).
Mentions: A 46-year-old woman was referred after having general weakness for one month. Biochemical indices of liver function were normal. The tumor markers revealed the following: alpha-fetoprotein level, 2.1 ng/mL (< 9.6 ng/mL); carcinoembryonic antigen level, 1.5 ng/mL (< 5.0 ng/mL); serum carbohydrate antigen 19-9 level, 13.2 U/mL (< 39 U/mL). Serum markers for hepatitis B and C were negative. Ultrasonography showed a lobulate heterogeneous echogenic solid mass with a highly echogenic lesion with posterior acoustic shadowing within the mass in the left lobe of the liver (Fig. 1A). Computed tomographic analysis of the mass revealed peripheral enhancing viable portions, large internal non-enhancing necrotic portions, and a dense radiopaque lesion (Figs. 1B-E). The enhancing portion of this mass was hypoattenuating in the precontrast scan (Fig. 1B), hyperattenuating in the arterial phase (Fig. 1C), hypoattenuating in the portal phase (Fig. 1D), and isoattenuating in the equilibrium phase (Fig. 1E). Upon magnetic resonance imaging, this mass was observed to be hypointense on the T1-weighted image (Fig. 1F) and hyperintense on the T2-weighted image (Fig. 1G). On the T2-weighted images, peripheral viable portions were slightly hyperintense, internal necrotic portions were moderately hyperintense, and small central cystic portions were very hyperintense. Calcification and ossification had low or dark signal intensity on the T1- and T2-weighted images (Figs. 1F, G).

Bottom Line: Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described.We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology.Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. kjh2603@dsmc.or.kr

ABSTRACT
Primary hepatic carcinosarcoma is a rare tumor comprised of a mixture of carcinomatous and sarcomatous elements. Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described. We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology. Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.

Show MeSH
Related in: MedlinePlus