A Rare Case of an Incidental Finding of Sarcomatoid Hepatocellular Carcinoma

Introduction: Sarcomatoid hepatocellular carcinoma (SHC) is an extremely rare subtype of morphologic hepatocellular carcinoma. The exact pathogenic mechanisms of SHC remain unknown. Preferred treatment is surgical resection and overall prognosis remains poor due to recurrence. We present a unique case of a 68 year old female with a prior history of hepatitis C who was treated with Harvoni and presented two years later with a liver mass that was found to be positive for primary sarcomatoid hepatocellular carcinoma. Case Description/Methods: A 68 year old female presented with early satiety and abdominal pain. The patient had undergone bi-directional endoscopic evaluation previously which was unremarkable. No hepatitis C RNA was detected in lab work but an ultrasound of the abdomen revealed a focal liver mass. The patient was referred to our transplant center and presented with mild abdominal tenderness without any rebound, guarding, or rigidity during the physical exam. An AFP of 5.4 ng/mL was the only lab value of significance. An MRI with and without contrast revealed a 6 cm liver mass with a large posterior pericaval upper retroperitoneal node measuring 2.6 cm x 3.7 cm, small 1.5 cm or less upper peripancreatic and porta hepatis nodes, and splenomegaly. Liver morphology suggested mild cirrhosis. A CT scan of the chest showed numerous pulmonary nodules. These findings were indicative of malignancy and a biopsy of the liver detected sarcomatoid hepatocellular carcinoma. Given the rare nature of the tumor she was referred for chemotherapy and also underwent radiofrequency ablation. Discussion: Both hepatitis C and hepatocellular carcinoma are associated with the development of sarcomatoid hepatocellular carcinoma. This is a unique presentation of a rare hepatic sarcomatoid tumor present in a female who was previously treated for hepatitis C with no prior history of hepatocellular carcinoma. This malignancy accounts for less than 2.0% of all patients undergoing surgery. This case highlights the rarity and subtle symptoms associated with the tumor. In the future, additional studies will be required to determine the impact of adjunctive chemotherapy with or without surgical resection on survival rates.Figure 1.: Immunohistochemistry stain of the liver showing vimentin, magnified at 10x suggesting Sarcomatoid Hepatocellular Carcinoma.