Hepatocellular carcinoma with sarcomatous change: characteristic findings of two-phased incremental CT.

ABSTRACT

BACKGROUND: Because of its poor prognosis, the diagnosis of hepatocellular carcinoma with sarcomatous change (HCCSC) is clinically important. The purpose of this study is to elucidate the characteristic CT findings of HCCSC. METHODS: Two-phased dynamic incremental CT images of six histologically proven HCCSC were retrospectively reviewed. RESULTS: All tumors (100%) exhibited peripheral enhancement on delayed CT images. Lymphadenopathy was observed in 100% (six of six patients); intrahepatic metastases, in 83% (five of six). Both metastatic lesions showed findings similar to those of the primary hepatic tumors, such as peripheral enhancement. Histopathological delayed and/or prolonged peripherally enhanced areas consisted of viable cancer cells with sarcomatous changes. CONCLUSIONS: The appearance of HCCSC on CT is that of an irregularly demarcated intrahepatic mass with delayed or prolonged peripheral enhancement, frequently with intrahepatic metastases and lymphadenopathy.