J Comput Assist Tomogr 2008;32:745-749
Hye Ryoung Koo, MD, Mi-Suk Park, MD, Myeong-Jin Kim, MD, Joon Suk Lim, MD, Jeong-Sik Yu, MD, Hur Jin, MD, and Ki Whang Kim, MD
Objective: To evaluate the imaging and clinical findings of pathologically proven sarcomatoid hepatocellular carcinoma (HCC) in 11 cases.
Methods: We retrospectively reviewed the imaging findings and clinical features of 11 patients with pathologically proven sarcoma¬toid HCC at 2 university-based tertiary institutions from July 1997 to June 2006.
Results: The most common gross morphologies of sarcomatoid HCC were massive expanding pattern (n = 6 [54%]) or multinodular confluent (n = 5 [46%]) with partial encapsulation (n = 9 [82%]). The most common enhancement pattern was peripheral enhancement with central necrosis (n = 8 [72%]) without a dominant dynamic pattern of enhancement. Six (54%) of 11 patients were positive for hepatitis B surface antigen or hepatitis C virus antibody. Only 1 patient (9%) had more than 500 ng/mL of preoperative serum a-fetoprotein.
Conclusions: In a patient with low-level a-fetoprotein and no history of viral hepatitis, sarcomatoid HCC usually presents as a large mass with peripheral enhancement, central necrosis, variable enhancement of the solid portion with or without tumor capsule, and intrahepatic metastasis.