Korean J Gastroenterol.  2010 Feb;55(2):144-148. 10.4166/kjg.2010.55.2.144.

A Case of Undifferentiated (Embryonal) Liver Sarcoma Mimicking Klatskin Tumor in an Adult

• Lee JA
• Kim TW
• Min JH
• Byon SJ
• Jang SH
• Choi SY
• Kim HJ

• KMID: 1718299
• DOI: http://doi.org/10.4166/kjg.2010.55.2.144

Abstract

Undifferentiated sarcoma is an uncommon primary malignant tumor of the liver typically occurring in older children. It is also referred to as malignant mesenchymoma, fibromyxosarcoma, or mesenchymal sarcoma. We experienced a case of undifferentiated sarcoma in 72-year-old male. Contrast enhanced liver CT scan revealed a 3.4 cm heterogeneously enhancing, ill-defined, and low attenuated mass in the left liver and subtle intrahepatic duct dilatation. And, in tubogram, there were segmental stenosis and occlusion from the hilum to the proximal common bile duct. We did ultrasonography guided liver biopsy. The pathologic finding revealed infiltrative growth of atypical cells with rhabdoid features. Some atypical cells showed clear cytoplasm, but no organoid pattern was identified. The stroma around atypical cells was filled with eosinophilic hyaline material. These tumor cells were positive for vimentin only, and the tumor was consistent with undifferentiated sarcoma of the liver.

Keyword

Sarcoma; Liver

MeSH Terms

Aged
Bile Ducts, Intrahepatic/pathology
Diagnosis, Differential
Dilatation, Pathologic
Humans
Klatskin's Tumor/diagnosis
Liver Neoplasms/*diagnosis/pathology/ultrasonography
Male
Positron-Emission Tomography
Sarcoma/*diagnosis/pathology/ultrasonography
Tomography, X-Ray Computed
Tuberculosis/drug therapy/radiography
Vimentin/metabolism

Figure

• 

  Fig. 1. Post-contrast liver CT scan. The picture showed 3.4 cm heterogenously enhancing, ill-defined, and low attenuated mass in the left lobe of the liver. There was subtle intrahepatic duct dilatation in the left liver.

• 

  Fig. 2. Tubogram of the biliary tree. There were several segmental stenosis from the hilum to the proximal common bile duct.

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  Fig. 3. Microscopic findings of the liver mass. (A) Infiltrative growth of atypical cells with rhabdoid features (H&E stain, ×200). (B) Tumor cells were negative against CK stain (CK, ×200). (C) Tumor cells are positive against vimentin stain (vimentin, ×200).

• 

  Fig. 4. Microscopic findings of the liver mass. (A) In the high power view, some atypical cells showed clear cytoplasm, but no organoid pattern was identified (H&E stain, ×400). (B) The stroma around atypical cells was filled with eosinophilic hyaline material (H&E stain, ×1,000).

• 

  Fig. 5. Whole body PET CT. It showed a hypermetabolic mass (SUV=7.7) in central portion of the left liver segment 4. And, there was active tuberculosis with partly increased FDG uptake in the right lung. There was no metastatic lesion.

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