Sarcomatoid intrahepatic cholangiocarcinoma mimicking liver abscess: A case report

Table 1 Summary of sarcomatous intrahepatic cholangiocarcinoma reported in English-language literature from 1992 to 2019

Ref.	Case No.	Age/sex	Clinical symptom	Location	Size (cm)	Treatment	Outcome (mo)
Nakajima et al[1]	1	84/F	Anorexia, jaundice, abdominal pain	Hepatic hilum	3.5	None	Died 3
	2	45/F	Fever	Right lobe	14.0	Surgery	Died 4.5
	3	73/F	Abdominal mass	Left lobe	7.0	Chemotherapy	Died 5
	4	37/M	Abdominal discomfort, epigastralgia	Left lobe	10.0	None	Died 2.5
	5	64/M	Abdominal discomfort, nausea	Left lobe	7.5	TAE	Died 1
	6	52/M	Right hypochondralgia	Right lobe	7.5	TAE	Died 2
	7	69/M	Fever	Left lobe	10.0	Surgery	Well 36
Inoue et al[2]	8	61/M	Abdominal pain, distention	Left lobe	25.0	Surgery	Died 1.1
Haratake et al[4]	9	59/M	Fever, icterus, abdominal mass	Hepatic hilar	NA	Supportive	Died 1
Imazu et al[5]	10	77/M	Liver tumor	Left lobe	7.0	Surgery	NA
Honda et al[6]	11	61/F	Back pain	Right and Left lobe	NA	Supportive	Died 3.8
Matsuo et al[7]	12	77/F	Abdominal pain	Left lobe	4.3	Surgery	Died 5
Itamoto et al[8]	13	70/M	Fatigue, fever	Right lobe	8.0	Surgery	Well 9
Kaibori et al[9]	14	69/F	Fever, abdominal pain	Left lobe	20.0	Surgery	Died 3
Gupta et al[10]	15	50/M	Jaundice	Hepatic hilum	2.0	NA	NA
Lim et al[11]	16	41/F	Palpable epigastric mass	Left lobe	17.0	Surgery	Alive 2
Sato et al[12]	17	87/M	Elevated ductal enzyme levels	Left lobe	4.0	Supportive	Died 3
Malhotra et al[13]	18	60/F	Abdominal pain, abdominal mass	Left lobe	20.0	Surgery and chemotherapy	Well 29
Bilgin et al[14]	19	48/M	Abdominal pain, fatigue	Left lobe	13.0	Surgery and chemotherapy	Alive 12
Jung et al[15]	20	59/M	Pain, dizziness, mild fever	Right lobe	18.0	Surgery and chemotherapy	Well 8
Watanabe et al[16]	21	62/M	Liver tumor, jaundice	Hepatic hilum	4.5	Surgery and chemotherapy	Died 11
Kim et al[17]	22	67/M	Abdominal pain	Left lobe	6.0	Surgery	Alive 6
Shi et al[18]	23	55/M	NA	Right lobe	NA	Surgery	Died 2
	24	47/M	NA	Right lobe	NA	Surgery	Died 6
Zhang et al[19]	25	63/M	Abdominal pain	Left lobe	NA	Surgery	Well 4
Kim et al[20]	26	45/M	Abdominal pain	NA	7.5	Chemotherapy	Died 1.6
	27	67/M	Abdominal pain	NA	2.5	Chemotherapy	Died 4.9
	28	55/M	Abdominal pain, fever	NA	6.5	Chemotherapy	Died 4.3
	29	66/M	Abdominal pain, fever	NA	10.0	Supportive	Died 0.7
	30	56/M	Abdominal pain, fatigue	NA	8.0	Chemotherapy	Died 2.4
	31	66/M	Abdominal pain	NA	7.5	Chemotherapy	Died 4.2
	32	68/M	BWL, fatigue	NA	6.0	Supportive	Died 0.6
	33	55/M	Abdominal pain, fever	NA	8.5	Chemotherapy	Died 1
	34	49/M	Abdominal pain, fever	NA	9.5	Chemotherapy	F/U
	35	65/M	Abdominal pain	NA	9.5	Supportive	Died 0.5
	36	61/M	Abdominal pain	NA	5.0	Viscum album	Alive 12.7
Tsou et al[21]	37	77/F	Abdominal pain, palpable mass, BWL	Left lobe	14.0	None	Died 2
	38	62/M	Abdominal pain, BWL	Right lobe	3.0	Unknown	F/U
	39	59/M	Abdominal pain, palpable mass, BWL	Left lobe	11.0	None	Died 1
	40	63/M	Dyspnea, BWL	Right lobe	14.0	None	Died 0.3
	41	64/M	Back pain	Left lobe	11.0	Surgery	Died 2
	42	50/F	Abdominal pain	Right lobe	4.5	Surgery	Died 2
	43	69/F	Abdominal pain, fever	Left lobe	2.5	Surgery	Alive 48
Our case	44	43/M	Abdominal discomfort	Right lobe	7.0	Surgery	Died 2.5

F: Female; M: Male; BWL: Body weight loss; TAE: Transarterial embolization; NA: Not available; F/U: Lost to follow-up.

Table 2 Clinical characteristics of sarcomatous intrahepatic cholangiocarcinoma reported in the English-language reports and our case

Clinical characteristics		Number
Age (yr)1		60.8 ± 11.3, 61.5
Gender (Male/Female)		33:11 (3:1)
Clinical symptoms
Abdominal pain/discomfort		26/44 (59.1%)
Fever		11/44 (25.0%)
Abdominal mass		6/44 (13.6%)
Jaundice		4/44 (9.0%)
Digestive symptoms		2/44 (4.5%)
Fatigue		4/44 (9.0%)
Back pain		2/44 (4.5%)
Body weight loss		4/44 (9.0%)
Dizziness		1/44 (2.3%)
None		2/44 (4.5%)

¹Values for age are presented as means ± SD (n = 44) and median.

Table 3 Summary of radiological features of 44 patients

		Radiological features	Number
Location		Left lobe	18/44 (40.9%)
		Right lobe	10/44 (22.7%)
		Hepatic hilum	4/44 (9.0%)
		Multiple	1/44 (2.3%)
		Unknown	11/44 (25.0%)
Tumor size (cm)1			9.0 ± 5.2
US		Hypoechoic	6/23 (26.1%)
		Hyperechoic	3/23 (13.0%)
		Mixed-echoic	10/23 (45.5%)
		Unseen	1/23 (4.3%)
		Unknown	3/23 (13.0%)
CT	Plain	Low density	19/19 (100%)
	Enhancement	Enhanced peripheral areas (progressive enhancement to the central region)	22/23 (95.7%)
			(12/23) (52.2%)
		Without enhancement	1/23 (4.3%)
MRI	T1 WI	Iso/Low intensity	6/8 (75.0%)
	T2 WI	High intensity border	1/8 (12.5%)
		High and low intensity	5/8 (62.5%)
	Unknown		2/8 (25.0%)
	Enhancement	Enhanced peripheral areas (progressive enhancement to the central region)	2/8 (25.0%)
			(2/8) (25.0%)
	Unknown		6/8 (75.0%)
Angiography		Hypovascularity	1/3 (33.3%)
		Unknown	2/3 (66.7%)

¹Values for tumor size are presented as means ± SD (n = 44). CT: Computed tomography; MRI: Magnetic resonance imaging.s