Rapidly Progressing Sarcomatoid Hepatocellular Carcinoma after Needle Biopsy and Radiofrequency Ablation

Objective: Unusual clinical course Background: Sarcomatoid hepatocellular carcinoma is a rare, primary malignant liver cancer. Its pathogenesis is unknown, but it often occurs in patients who have undergone repeated antitumor therapies for hepatocellular carcino-ma. Sarcomatoid hepatocellular carcinoma is more likely to recur and has a worse prognosis than that of he-patocellular carcinoma. As no specific features have been identified in the symptoms, serological findings, or imaging findings, it is difficult to accurately diagnose the disease before surgical resection or autopsy. Case Report: An 83-year-old woman was diagnosed with hepatocellular carcinoma 20 years ago. Radiofrequency ablation was initially performed. Thereafter, invasive, non-surgical treatments were repeated. The most recent treat-ment was 4 years ago, during which computed tomography suggested recurrent hepatocellular carcinoma. However, upon needle biopsy, histological examination revealed spindle-shaped tumor cells and actively mi-totic cells. Immunohistochemical analysis showed negative results for Arginase-1, HepPar1, and Glypican3 and positive results for AE1/AE3, CK7, and vimentin. Therefore, sarcomatoid hepatocellular carcinoma was diag-nosed, which was treated with radiofrequency ablation but progressed rapidly thereafter. Considering the rap-id disease progression, the patient was treated conservatively. However, the patient's general condition grad-ually deteriorated, resulting in death. Conclusions: Compared with hepatocellular carcinoma, sarcomatoid hepatocellular carcinoma is more prone to recurrence and has a poorer prognosis. Therefore, aggressive surgical resection seems to be the most appropriate treat-ment for sarcomatoid hepatocellular carcinoma at present. Additional hepatic resection or follow-up imaging in a short period should be considered at the time of diagnosis of sarcomatoid hepatocellular carcinoma by bi-opsy, considering the risk of seeding or recurrence.

Automated summary

This article reports a case of rare sarcomatoid hepatocellular carcinoma, which was initially misdiagnosed as hepatocellular carcinoma, leading to inappropriate treatment. Sarcomatoid hepatocellular carcinoma is more likely to recur and has a worse prognosis. Aggressive surgical resection seems to be the most appropriate treatment for this rare cancer.