Bin Fengli, Chen Zhihong, Liu Peng, Liu Jianbin, Mao Zhiqun
Department of Radiology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People's Republic of China.
Department of Pathology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People's Republic of China.
J Hepatocell Carcinoma. 2020 Oct 13;7:169-180. doi: 10.2147/JHC.S272768. eCollection 2020.
To improve the understanding of hepatic carcinosarcoma (HCS) by analyzing radiological imaging data and clinicopathological features.
A retrospective analysis was performed on four patients with HCS confirmed immunohistochemically. The analysis included three males and one female, aged 29 to 64 years. Four patients underwent computed tomography (CT) scans, and one underwent magnetic resonance imaging (MRI) scans simultaneously.
Three patients had a history of hepatitis B, cirrhosis or fibrosis, and two patients had schistosomiasis. Two cases tested positive for elevated serum carbohydrate antigen (CA) 19-9. The maximum diameters of the lesions ranged from 7.8 to 9.0cm. Pathologically, the carcinomatous and sarcomatous elements in two patients could not be classified, one of the patients had cholangiocellular carcinoma (CCC) and undifferentiated sarcoma, the other had hepatocellular carcinoma (HCC) and undifferentiated pleomorphic sarcoma (UPS). All tumors showed heterogeneous density/intensity, accompanied by vast cystic changes and necrosis, with two cases having cystic septations. Capsule formation was not identified. The margins of the radiological images showed irregular ring enhancement. One case presented continuous progressive enhancement, one case with "fast in fast washout" and two cases with "fast in late washout". Lymphonodus metastasis, satellite nodules, vascular embolism, and organ invasion (hepatic flexure of the colon) were identified.
HCS is a rare, high-grade malignancy with poor prognosis. The preoperative diagnosis is expected to improve by carefully analyzing the imaging features of the patients in combination with their clinical characteristics. Radical resection and postoperative chemoradiotherapy can improve the survival rate of patients.
通过分析影像学数据和临床病理特征，提高对肝肉瘤样癌（HCS）的认识。
对4例经免疫组织化学确诊的HCS患者进行回顾性分析。分析对象包括3名男性和1名女性，年龄在29至64岁之间。4例患者接受了计算机断层扫描（CT），1例同时接受了磁共振成像（MRI）扫描。
3例患者有乙肝、肝硬化或纤维化病史，2例患者有血吸虫病。2例患者血清糖类抗原（CA）19-9升高检测呈阳性。病变的最大直径为7.8至9.0厘米。病理上，2例患者的癌性和肉瘤性成分无法分类，其中1例患者为胆管细胞癌（CCC）和未分化肉瘤，另1例为肝细胞癌（HCC）和未分化多形性肉瘤（UPS）。所有肿瘤均表现为密度/信号不均匀，伴有大量囊性改变和坏死，2例有囊内分隔。未发现包膜形成。影像学图像边缘呈不规则环形强化。1例呈持续渐进性强化，1例呈“快进快出”，2例呈“快进慢出”。发现有淋巴结转移、卫星结节、血管栓塞和器官侵犯（结肠肝曲）。
HCS是一种罕见的高级别恶性肿瘤，预后较差。通过结合患者的临床特征仔细分析影像学特征，有望提高术前诊断水平。根治性切除和术后放化疗可提高患者生存率。
