Imaging features of primary hepatic sarcomatoid carcinoma: Differentiation from hepatocellular carcinoma and intrahepatic cholangiocarcinoma on CT: A preliminary study. Issue 3 (March 2023)

• Record Type: Journal Article
• Authors: Chen, Lintao; Ruan, Shijian; Wang, Pan; Cheng, Yongna; Wang, Yubizhuo; Tian, Wuwei; Zhang, Hongbin; Zhang, Xiuming; Liang, Wenjie
• Is Part Of: Heliyon. Volume 9:Issue 3(2023)
• Publication Date: 2023-03
• Subjects: Hepatic sarcomatoid carcinoma -- Imaging -- Computed tomography -- Hepatocellular carcinoma -- Intrahepatic cholangiocarcinoma; PHSC primary hepatic sarcomatoid carcinoma -- CT computed tomography -- HCC hepatocellular carcinoma -- ICC intrahepatic cholangiocarcinoma -- APHE arterial phase hyperenhancement -- TACE transcatheter arterial chemoembolization -- H&E hematoxylin-eosin -- CKpan pan-cytokeratin -- GPC3 glypican-3 -- AFP alpha-fetoprotein -- CA199 carbohydrate antigen 19-9 -- CA125 carbohydrate antigen 12-5 -- CEA carcinoembryonic antigen -- MRI magnetic resonance imaging; Research -- Periodicals; Medical sciences -- Periodicals; Natural history -- Periodicals; Social sciences -- Periodicals; Earth sciences -- Periodicals; Physical sciences -- Periodicals; 507.2
• DOI: 10.1016/j.heliyon.2023.e14123
• Languages: English
• ISSNs: 2405-8440

Abstract

Abstract: Purpose: Primary hepatic sarcomatoid carcinoma (PHSC) is a rare type of malignant tumor in the liver. Nevertheless, few studies have focused on the imaging diagnosis of PHSC. In this study, we collected clinical and computed tomography (CT) imaging data of PHSC from two institutions, aiming to investigate the clinical and radiological characteristics of PHSC. Methods: We retrospectively investigated the clinical characteristics and CT features of 22 PHSC patients (19 males and 3 females; mean age, 63.4 years; range, 49 to 76 years), 95 hepatocellular carcinoma (HCC) patients and 50 intrahepatic cholangiocarcinoma (ICC) patients. Two radiologists independently evaluated the CT features of the three groups. Subsequently, we analyzed the differences in the clinical characteristics and CT features between the PHSC and control groups. Results: Most PHSCs were larger than 5 cm (72.7%). PHSC mainly showed irregular (81.8%), heterogeneous (100%) masses with ill-defined (72.7%) borders with necrosis (86.4%) on CT, which are more common CT features versus HCC ( p < 0.001). In the arterial phase, PHSC always showed noticeable heterogeneous enhancement (100.0%), mainly manifesting as partial arterial phase hyperenhancement (APHE) (86.4%). The enhancement patterns of PHSC mainly included delayed progressive enhancement (72.7%), nonperipheral washout (22.7%), and unclassified enhancement (4.5%), which were significantly different from the HCC enhancement pattern but similar to the enhancement pattern of ICC. In addition, vein tumor thrombus (18.2%), intrahepatic metastasis (27.3%), and lymphadenopathy (27.3%) were relatively common in PHSC. Furthermore, most PHSC tumors classified as LR-M (66.7%) were similar to ICC. Conclusions: PHSC generally presents as irregularly large masses with necrosis, intrahepatic metastasis, and lymphadenopathy. The CT enhancement of PHSC is mainly part of APHE and delayed progressive enhancement.