Case Report
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World J Hepatol. Sep 27, 2011; 3(9): 256-261
Published online Sep 27, 2011. doi: 10.4254/wjh.v3.i9.256
Simultaneous occurrence of malignant fibrous histiocytoma and hepatocellular carcinoma in cirrhotic liver: A case report
Hee Sang Hwang, Nam Du Ha, Yoong Ki Jeong, Jae Hee Suh, Hye Jeong Choi, Young Min Kim, Hee Jeong Cha
Hee Sang Hwang, Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, South Korea
Nam Du Ha, Yoong Ki Jeong, Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, South Korea
Jae Hee Suh, Hye Jeong Choi, Young Min Kim, Hee Jeong Cha, Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, South Korea
Author contributions: Hwang HS, Ha ND and Cha HJ contributed equally to the work; Hwang HS and Cha HJ designed and wrote the case report and discussion points; Ha ND and Jeong YK wrote the radiological features of the case report; Suh JH, Choi HJ and Kim YM designed, wrote the discussion points and acted as consultant for pathological features.
Correspondence to: Hee Jeong Cha, MD, PhD, Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, South Korea. heej0124@medimail.co.kr
Telephone: +82-52-2507260 Fax: +82-52-2523024
Received: January 24, 2011
Revised: September 14, 2011
Accepted: September 21, 2011
Published online: September 27, 2011
Abstract

Primary hepatic malignant fibrous histiocytoma (MFH) is rarely encountered. There have been no reports to date of hepatic MFH associated with liver cirrhosis. The presence of liver cirrhosis is considered an adjunctive feature favoring sarcomatoid hepatocellular carcinoma (HCC) in the diagnosis of spindle cell tumors in liver. We describe here a 59-year-old man with liver cirrhosis due to hepatitis B virus infection 20 years ago. On abdominal computed tomography scanning, two distinct hepatic masses were identified in the background of cirrhosis, which had different radiological features from conventional HCC. He underwent segmentectomy for removal of the tumors. The pathological examination of surgically resected specimen revealed the large malignant spindle cell tumor and small conventional HCC. Additional tissue sampling and immunohistochemical stainings demonstrated that the spindle cell tumor was consistent with MFH. On the post-operative follow-up for 21 mo, a round mass showing similar radiological findings for the previous MFH was appeared on the surface of resection margin, suggesting the recurrence. Despite its rarity, hepatic MFH should be considered during differential diagnosis, even in cirrhotic patients, and extensive tissue sampling and immunohistochemical analyses are necessary in the diagnosis of hepatic spindle cell tumors.

Keywords: Liver neoplasm; Malignant fibrous histiocytoma; Hepatocellular carcinoma; Liver cirrhosis