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The Clinicopathological and Imaging Characteristics of Primary Hepatic Carcinosarcoma and a Review of the Literature

Authors Bin F, Chen Z, Liu P, Liu J, Mao Z

Received 25 July 2020

Accepted for publication 10 September 2020

Published 13 October 2020 Volume 2020:7 Pages 169—180

DOI https://doi.org/10.2147/JHC.S272768

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Ahmed Kaseb


Fengli Bin,1 Zhihong Chen,2 Peng Liu,1 Jianbin Liu,1 Zhiqun Mao1

1Department of Radiology, Hunan Provincial People’s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People’s Republic of China; 2Department of Pathology, Hunan Provincial People’s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People’s Republic of China

Correspondence: Zhiqun Mao
Department of Radiology, Hunan Provincial People’s Hospital, First Affiliated Hospital of Hunan Normal University, No. 61, Jiefang West Road, Changsha, Hunan Province, People’s Republic of China
Tel +86 17708483616
Email mzq1979@126.com

Purpose: To improve the understanding of hepatic carcinosarcoma (HCS) by analyzing radiological imaging data and clinicopathological features.
Materials and Methods: A retrospective analysis was performed on four patients with HCS confirmed immunohistochemically. The analysis included three males and one female, aged 29 to 64 years. Four patients underwent computed tomography (CT) scans, and one underwent magnetic resonance imaging (MRI) scans simultaneously.
Results: Three patients had a history of hepatitis B, cirrhosis or fibrosis, and two patients had schistosomiasis. Two cases tested positive for elevated serum carbohydrate antigen (CA) 19– 9. The maximum diameters of the lesions ranged from 7.8 to 9.0cm. Pathologically, the carcinomatous and sarcomatous elements in two patients could not be classified, one of the patients had cholangiocellular carcinoma (CCC) and undifferentiated sarcoma, the other had hepatocellular carcinoma (HCC) and undifferentiated pleomorphic sarcoma (UPS). All tumors showed heterogeneous density/intensity, accompanied by vast cystic changes and necrosis, with two cases having cystic septations. Capsule formation was not identified. The margins of the radiological images showed irregular ring enhancement. One case presented continuous progressive enhancement, one case with “fast in fast washout” and two cases with “fast in late washout”. Lymphonodus metastasis, satellite nodules, vascular embolism, and organ invasion (hepatic flexure of the colon) were identified.
Conclusion: HCS is a rare, high-grade malignancy with poor prognosis. The preoperative diagnosis is expected to improve by carefully analyzing the imaging features of the patients in combination with their clinical characteristics. Radical resection and postoperative chemoradiotherapy can improve the survival rate of patients.

Keywords: hepatic carcinosarcoma, imaging, computed tomography, magnetic resonance imaging

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