Radiological and clinical features of sarcomatoid hepatocellular carcinoma in 11 cases.

OBJECTIVE

To evaluate the imaging and clinical findings of pathologically proven sarcomatoid hepatocellular carcinoma (HCC) in 11 cases.

METHODS

We retrospectively reviewed the imaging findings and clinical features of 11 patients with pathologically proven sarcomatoid HCC at 2 university-based tertiary institutions from July 1997 to June 2006.

RESULTS

The most common gross morphologies of sarcomatoid HCC were massive expanding pattern (n = 6 [54%]) or multinodular confluent (n = 5 [46%]) with partial encapsulation (n = 9 [82%]). The most common enhancement pattern was peripheral enhancement with central necrosis (n = 8 [72%]) without a dominant dynamic pattern of enhancement. Six (54%) of 11 patients were positive for hepatitis B surface antigen or hepatitis C virus antibody. Only 1 patient (9%) had more than 500 ng/mL of preoperative serum alpha-fetoprotein.

CONCLUSIONS

In a patient with low-level alpha-fetoprotein and no history of viral hepatitis, sarcomatoid HCC usually presents as a large mass with peripheral enhancement, central necrosis, variable enhancement of the solid portion with or without tumor capsule, and intrahepatic metastasis.