Primary combined hepatocellular-cholangiocellular sarcoma: An unusual case

Figure 1 Contrast-enhanced computed tomography showing a 5 cm × 7 cm mass in segments V-VIII of the liver. A: Baseline scan; B: Arterial phase; C: Portal venous phase; D: Delayed phase.

Figure 2 Microscopic appearance of the specimen (hematoxylin and eosin staining). A: Tumor-adjacent liver parenchyma showed portal cirrhosis (magnificaton × 100); B: A transitional zone could be defined between the carcinomatous (lower left) and sarcomatous components (upper right). There were intermingled cells of the two elements (magnificaton × 100); C: Foci of cholangiocellular carcinoma with various grades of differentiation (magnificaton × 100); D: Neoplastic osteoid and chondroid formation was observed in the sarcoma element (magnificaton × 100); E: Metastasis nodule was composed of undifferentiated sarcoma cells with deeply stained nuclei (magnificaton × 40); F: Higher-magnification view of the squared part in panel E.

Figure 3 Immunohistochemical expression of the carcinosarcoma. A: Pan-cytokeratin staining showed diffuse and strong signals for HCC cells; B: HCC elements showed various staining pattern for cytokeratin 19 with intermediate hepatobiliary cell-like tumor cells (arrows); C: Carcinomatous elements were strongly positive for epithelial membrane antigen; D: Spindle cells and chondrosarcoma cells (area fenced by dotted line) were positive for epithelial membrane antigen; E: Carcinoma cells were positive for CD117, as were ductular reactions (arrows) and undifferentiated cells (arrows, inset); F: Sarcoma cells were positive for CD117; G: Sarcomatous elements strongly stained for vimentin; H: Diffuse staining for smooth muscle actin in sarcoma cells; All magnifications are × 100.