Primary combined hepatocellular-cholangiocellular sarcoma: An unusual case

Table 1 Summary of reported cases of liver carcinosarcoma with combined hepatocellular cholangiocarcinoma

Ref.	Age (yr)	Sex	Positive tumor marker	HBV	HCV	Cirrhosis	Size (cm)	Sarcoma element	Treatment	Metastasis	Outcome
Nakajima et al[2]	74	M	-	-	NA	Precirrhotic fibrosis	15 × 13	Pleomorphic cells, spindle shaped cells, and osteoplastic cells	Mitomycin C	Liver, lung, lymph nodes, stomach, peritoneum	Died within 5 mo
Papotti et al[3]	59	M	-	-	-	-	4.0 × 5.2	Spindle cells	Right hepatectomy	PVTT	Died within 4 mo
Goto et al[1]	73	M	AFP	+	NA	+	3 × 2.5 × 2	Chondrosarcoma, osteosarcoma	Segmentectomy	-	19 mo, alive
			CEA
			CA19-9
			DCP
Present case	45	M	AFP	+	-	+	7 × 5	Chondrosarcoma, osteosarcoma, spindle cells, and bizarre cells	Segmentectomy	Diaphragm	7 mo, alive
			CA 12-5

AFP: Alfa-fetoprotein; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; DCP: Des-γ-carboxy prothrombin; HBV: Hepatitis B virus; HCV: Hepatitis C virus; NA: Not available; PVTT: Portal vein tumor thrombus.

Table 2 Results of immunohistochemistry

Marker	Carcinomatous component	Sarcomatouscomponent
EMA	++	+
CK19	++	-
CK8/18	++	-
Hepatocyte	++	-
Pan-CK	++	-
Galectin-3	+	+
CD117	+	+
VIM	-	++
SMA	-	++
S-100	-	+
DES	-	-
Ki-67	+	++

-: Negative; +: < 50% cells are positive or mildly immunostained; ++: Diffusely positive or strongly immunostained. CK: Cytokeratin; EMA: Epithelial membrane antigen; SMA: Smooth muscle actin; VIM: Vimentin; DES: Desmin.