Clinical Imaging Characteristics and Pathological Features of Sarcomatoid Hepatocellular Carcinoma

Objective: To explore the imaging manifestations and clinical-pathological features of sarcomatoid hepatocellular carcinoma (SHC). Methods: The clinical data, CT/MRI findings and pathological features of 7 patients with SHC were retrospectively analyzed and the consistency was evaluated. Results: SHC showed unclear boundary and low density by plain CT images, with the size ranging from 4.2 cm×4.7 cm–14.0 cm×11.0 cm. By enhanced CT images, SHC showed ring or early enhancement with large areas of necrosis. SHC showed heterogeneous signal intensity on T1WI and T2WI with visible cystic degeneration and necrotic area while DWI displayed obvious diffusion restricted changes. On enhanced MRI, the tumor showed progressive enhancement of peripheral and solid components with delayed enhanced pseudo-capsule. 6 cases had different degree of necrosis in the center of lesion, and lymph node metastasis in the livers hilar was found in 5 patients. Pathological features polygonal and fusiform tumor cells with extensive necrosis and hemorrhage were found on HE staining. Vimentin and CK were positive by immunohistochemical staining. Conclusions: The imaging findings of SHC were consistent with the pathological features, which was helpful to deep understanding of specific imaging manifeatations, and the diagnosis and differential diagnosis of liver tumors.