Page 104 - ARNM-3-3

Advances in Radiotherapy
& Nuclear Medicine Sarcomatoid HCC therapy

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Figure 5. H&E-stained histopathological features of metastatic HCC to
the colon, showing tumor cells resembling hepatocytes within the colonic
wall. Magnification: ×40.
Figure 3. CT imaging findings of recurrent tumor. (A) Multiple masses Abbreviations: HCC: Hepatocellular carcinoma; H&E: Hematoxylin and
and nodules in the greater omentum (red arrow). (B) A hypodense eosin.
nodule in the right liver parenchyma (red arrow).
Abbreviation: CT: Computed tomography.

Figure 6. Immunohistochemical staining with HepPar-1 is a useful
Figure 4. H&E-stained histopathological specimen showing trabecular tool to confirm the hepatic origin of metastatic tumors in the colon.
morphology of HCC after TACE at low magnification. Magnification: ×40 Magnification: ×100.
Abbreviations: HCC: Hepatocellular carcinoma; H&E: Hematoxylin and Abbreviation: HerPar-1: Hepatocyte paraffin 1.
eosin; TACE: Transarterial chemoembolization.

analysis of postoperative specimens confirmed metastatic
HCC (Figure 6).
In November 2023, a follow-up abdominal CT scan
showed a mass in segment VIII of the liver measuring
84 × 70 mm, with a well-defined boundary, strong, and
heterogeneous contrast enhancement in the arterial
phase, and wash-out in the venous phase (Figure 7). The
patient subsequently underwent another TACE session
at Bach Mai Hospital and was discharged for continued Figure 7. Axial contrast-enhanced CT image showing a right hepatic
monitoring. mass with characteristics of HCC (red arrow), demonstrating an increase
in size compared to the September 2023 scan
In January 2024, the patient had severe abdominal Abbreviations: CT: Computed tomography; HCC: Hepatocellular carcinoma.
pain and was admitted for an abdominal CT scan, which
showed a large mass with clear boundaries measuring intravenously on days 1 and 2; (ii) ifosfamide 3.75 g/m
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130 × 94 × 108 mm in the right liver lobe, including areas intravenously over 4 h on days 1 and 2; and (iii) Mesna
of increased density corresponding to interventional 750 g/m intravenously before each ifosfamide cycle, then
2
material and decreased density due to necrosis, with strong again at 4 h and 8 h after the ifosfamide infusion. Each
heterogeneous arterial-phase contrast enhancement, and cycle lasted 21 days.
venous phase wash-out (Figure 8).
After two chemotherapy cycles, the patient developed
The patient was subsequently initiated on systemic elevated liver enzymes, prompting the medical team
chemotherapy with the anthracycline-ifosfamide-mesna to discontinue chemotherapy and switch to supportive
regimen, which included (i) doxorubicin 30 mg/m medical management.
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Volume 3 Issue 3 (2025) 96 doi: 10.36922/ARNM025220024