Page 103 - ARNM-3-3

Advances in Radiotherapy
& Nuclear Medicine Sarcomatoid HCC therapy

Several clinical trials have suggested that transarterial Mai Hospital diagnosed the tumor as SHC with cirrhosis
chemoembolization (TACE), radiofrequency ablation and 80% tumor necrosis (Figure 2). The patient recovered
(RFA), and percutaneous ethanol injection (PEI) may postoperatively and was discharged for follow-up.
contribute to the transformation from HCC to SHC. In September 2023, during a routine follow-up,
1
However, SHC has also been reported in patients an abdominal CT scan revealed multiple masses and
without a history of these treatments, indicating that its nodules of heterogeneous density with variable contrast
exact pathogenesis remains unclear. At present, there enhancement in the greater omentum close to the left
is no established effective treatment for SHC. Surgical anterior abdominal wall, the largest measuring 47 × 34 mm
resection remains the primary therapeutic approach, with (Figure 3A). A well-defined nodule measuring 25 × 18 mm
additional regional and systemic therapies; however, their with poor enhancement was observed in segment
efficacy in improving survival outcomes has not been well VIII of the liver parenchyma (Figure 3B). This nodule
demonstrated. exhibited the typical trabecular morphology of HCC on
We herein present a clinical case of a male patient histopathological examination (Figure 4).
diagnosed with SHC who experienced multiple recurrences The patient was diagnosed with recurrent SHC and
and underwent multimodal treatment, including TACE, subsequently underwent colectomy, small intestine
surgery, and systemic chemotherapy. resection, and PEI (Figure 5). Immunohistochemical

2. Case presentation
A B
A 57-year-old male patient with a history of hepatitis B,
treated for 10 years but now off treatment, was diagnosed
with HCC in 2013 and underwent TACE five times at Bach
Mai Hospital, Hanoi, Vietnam.
In April 2023, the patient was diagnosed with recurrent
HCC and underwent a sixth TACE at Duc Giang General
Hospital, Hanoi, Vietnam. He was discharged for follow-up
after treatment.

In May 2023, the patient was admitted to the hospital
due to dull abdominal pain, anorexia, severe nausea, and Figure 1. Imaging findings of recurrent liver tumor after TACE.
(A) Contrast-enhanced CT scan showing a large mass in the left liver (red
a weight loss of 5 kg over 1 month. Abdominal computed arrow). (B) MRI exhibiting a heterogeneous mass occupying most of the
tomography (CT) revealed a left liver tumor measuring left liver lobe, with dynamic characteristics of HCC (red arrow).
25 × 35 mm with decreased density and no contrast Abbreviations: CT: Computed tomography; MRI: Magnetic resonance
enhancement (Figure 1A), and a large tumor measuring imaging; TACE: Transarterial chemoembolization.
97 × 145 mm occupying almost the entire left liver
lobe, with characteristics suggestive of HCC. Magnetic
resonance imaging (MRI) showed a localized mass in
segment VI measuring 40 × 39 × 24 mm with no contrast
enhancement. Adjacent to the left liver lobe, there was
a large heterogeneous mass measuring 94 × 153 mm,
exhibiting central and peripheral necrosis, arterial-phase
contrast enhancement, and venous phase wash-out
(Figure 1B). In addition, segment II had a 28 × 18 × 20 mm
nodule with similar characteristics, continuous with the
mass in the left liver lobe.
The patient was diagnosed with recurrent HCC
after six TACE sessions, and a multidisciplinary team
recommended surgical intervention. The patient
underwent left lobectomy, partial resection of segment VI, Figure 2. H&E-stained histopathological specimen showing malignant
and cholecystectomy. Specimens were fixed in formalin, spindle cell proliferation of SHC on the right side, with tumor nests of
HCC on the lower left corner. Magnification: ×100.
then embedded in paraffin, and stained with hematoxylin Abbreviations: HCC: Hepatocellular carcinoma; H&E: Hematoxylin and
and eosin. Pathologists at the Pathology Center of Bach eosin; SHC: Sarcomatoid hepatocellular carcinoma.

Volume 3 Issue 3 (2025) 95 doi: 10.36922/ARNM025220024