Radiological and Clinical Features of Sarcomatoid Hepatocellular Carcinoma in 11 Cases

Objective: To evaluate the imaging and clinical findings of pathologically proven sawrcomatoid hepatocellular carcinoma (HCC) in 11 cases. Methods: We retrospectively reviewed the imaging findings and clinical features of 11 patients with pathologically proven sarcomatoid HCC at 2 university-based tertiary institutions from July 1997 to June 2006. Results: The most common gross morphologies of sarcomatoid HCC were massive expanding pattern (n = 6 [54%]) or multinodular confluent (n = 5 [46%]) with partial encapsulation (n = 9 [82%]). The most common enhancement pattern was peripheral enhancement with central necrosis (n = 8 [72%]) without a dominant dynamic pattern of enhancement. Six (54%) of 11 patients were positive for hepatitis B surface antigen or hepatitis C virus antibody. Only 1 patient (9%) had more than 500 ng/mL of preoperative serum alpha-fetoprotein. Conclusions: In a patient with low-level a-fetoprotein and no history of viral hepatitis, sarcomatoid HCC usually presents as a large mass with peripheral enhancement, central necrosis, variable enhancement of the solid portion with or without tumor capsule, and intrahepatic metastasis.