Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2015; 21(23): 7335-7342
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7335
Primary combined hepatocellular-cholangiocellular sarcoma: An unusual case
Shuai Xiang, Yi-Fa Chen, Yan Guan, Xiao-Ping Chen
Shuai Xiang, Yi-Fa Chen, Yan Guan, Xiao-Ping Chen, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Xiang S, Chen YF and Chen XP performed the operation; Guan Y performed histologic experiments; Xiang S and Chen XP wrote the paper; Chen XP critically revised the paper.
Supported by Grants from the Hepatic Surgery Clinical Study Center of Hubei Province, China, No. 2014BKB089.
Ethics approval: The study was reviewed and approved by the Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
Informed consent: The patient and his wife provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Ping Chen, MD, PhD, FACS, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefangdadao, Wuhan 430030, Hubei Province, China. chenxpchenxp@163.com
Telephone: +86-27-83663500 Fax: +86-27-83663500
Received: November 12, 2014
Peer-review started: November 15, 2014
First decision: January 22, 2015
Revised: February 10, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: June 21, 2015
Processing time: 220 Days and 6.2 Hours
Abstract

Primary liver carcinosarcoma is rare. Here we report an unusual case of liver carcinosarcoma containing combined hepatocellular cholangiocarcinoma. A mass in the right liver lobe of a 45-year-old man was accidentally discovered by ultrasonic inspection and computed tomography (CT) scan. Surgical resection was performed following a diagnosis of primary liver cancer. Micropathologically, both carcinomatous and sarcomatous elements were present, and diagnosis of liver carcinosarcoma was confirmed. The carcinomatous element consisted of hepatocellular carcinoma and foci of cholangiocellular carcinoma. The sarcomatous element was composed of spindle cells and bizarre cells, as well as foci of osteosarcoma and chondrosarcoma. Hepatocellular carcinoma cells diffusely expressed both hepatocyte specific markers cytokeratin (CK) 8/18 and cholangiocyte specific markers CK19, and sarcoma cells were positive for vimentin. Interestingly, both carcinomatous and sarcomatous cells expressed epithelial membrane antigen. CD117-positive ductular reactions and small undifferentiated cells were observed. A liver progenitor cell origin of the liver carcinosarcoma was proposed.

Keywords: Carcinosarcoma; Cholangiocellular carcinoma; Hepatocellular carcinoma; Liver neoplasm; Stem cells

Core tip: Primary mixed-type hepatocellular-cholangiocellular sarcoma is extremely rare. The histogenetic origin of this tumor is controversial. We report a case with special characteristics and propose a new hypothesis combining stem cell theory and “conversion” theory, which may be more appropriately applied to this case.