Abdominal Radiology

, Volume 42, Issue 5, pp 1424–1433 | Cite as

Imaging features of hepatic sarcomatous carcinoma on computed tomography and gadoxetic acid-enhanced magnetic resonance imaging

  • Kyo-won Gu
  • Young Kon KimEmail author
  • Ji Hye Min
  • Sang Yun Ha
  • Woo Kyoung Jeong



To determine the imaging features of hepatic sarcomatous carcinoma including sarcomatous intrahepatic cholangiocarcinoma (S-ICC) and sarcomatous hepatocellular carcinoma (S-HCC) on computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI).

Materials and methods

Twenty-four patients with pathologically confirmed S-ICCs (n = 13), S-HCCs (n = 7), sarcomatous carcinoma (n = 2), carcinosarcoma (n = 1), and sarcomatous combined HCC–CC (n = 1) (size range 2.1–23 cm, mean 8.3 cm) underwent gadoxetic acid-enhanced MRI (n = 20) and/or dynamic CT (N = 24). Underlying chronic hepatitis or cirrhosis was found in 17 patients. Two reviewers evaluated morphology, signal intensity, and enhancement features of tumors based on a consensus.


Lobulated contour was observed in 15 tumors (62.5%); the rest were round or oval masses. During dynamic imaging, S-ICCs showed poor enhancement (n = 10 on CT; n = 7 on MRI) or initial thin-rim enhancement with/without progressive enhancement (n = 3 on CT; n = 6 on MRI). S-HCCs and the other four tumors showed a thin or thick enhancement pattern on both CT and MRI. T2 bright signal intensity similar to fluid was found in 10 tumors. Target appearance on hepatobiliary phase and diffusion-weighted imaging was seen in two S-ICCs and two S-HCCs. Of 18 surgically resected tumors, 17 showed vascular invasion and/or thrombosis in histology and 12 in CT and MRI. Ten tumors were accompanied by intrahepatic metastasis or tumor seeding and 19 patients had recurrence or progression of tumors during follow-up.


Hepatic sarcomatous carcinoma including S-HCC and S-ICC generally presents minimal rim-like arterial enhancement or extreme hypovascularity on CT and gadoxetic acid-enhanced MRI with a high frequency of T2 bright area due to extensive necrosis and vascular invasion.


Sarcomatous carcinoma Cholangiocarcinoma Hepatocellular carcinoma Gadoxetic acid Magnetic resonance imaging 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


  1. 1.
    Kakizoe S, Kojiro M, Nakashima T (1987) Hepatocellular carcinoma with sarcomatous change. Clinicopathologic and immunohistochemical studies of 14 autopsy cases. Cancer 59:310–316CrossRefGoogle Scholar
  2. 2.
    Nishi H, Taguchi K, Asayama Y, et al. (2003) Sarcomatous hepatocellular carcinoma: a special reference to ordinary hepatocellular carcinoma. J Gastroenterol Hepatol 18:415–423CrossRefGoogle Scholar
  3. 3.
    Nakajima T, Tajima Y, Sugano I, et al. (1993) Intrahepatic cholangiocarcinoma with sarcomatous change. Clinicopathologic and immunohistochemical evaluation of seven cases. Cancer 72:1872–1877CrossRefGoogle Scholar
  4. 4.
    Watanabe G, Uchinami H, Yoshioka M, Nanjo H, Yamamoto Y (2014) Prognosis analysis of sarcomatous intrahepatic cholangiocarcinoma from a review of the literature. Int J Clin Oncol 19:490–496. doi: 10.1007/s10147-013-0586-x CrossRefPubMedGoogle Scholar
  5. 5.
    Kaibori M, Kawaguchi Y, Yokoigawa N, et al. (2003) Intrahepatic sarcomatoid cholangiocarcinoma. J Gastroenterol 38:1097–1101. doi: 10.1007/s00535-003-1203-y CrossRefPubMedGoogle Scholar
  6. 6.
    Sumiyoshi S, Kikuyama M, Matsubayashi Y, et al. (2007) Carcinosarcoma of the liver with mesenchymal differentiation. World J Gastroenterol 13:809–812CrossRefGoogle Scholar
  7. 7.
    Tsou YK, Wu RC, Hung CF, Lee CS (2008) Intrahepatic sarcomatoid cholangiocarcinoma: clinical analysis of seven cases during a 15-year period. Chang Gung Med J 31:599–605PubMedGoogle Scholar
  8. 8.
    Malhotra S, Wood J, Mansy T, et al. (2010) Intrahepatic sarcomatoid cholangiocarcinoma. J Oncol 2010:701476. doi: 10.1155/2010/701476 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hamilton SR, Aaltonen LA (2000) Pathology and genetics of tumours of the digestive system. Lyon: IARC pressGoogle Scholar
  10. 10.
    Lin YS, Wang TY, Lin JC, et al. (2013) Hepatic carcinosarcoma: clinicopathologic features and a review of the literature. Ann Hepatol 12:495–500PubMedGoogle Scholar
  11. 11.
    Schneider G, Massmann A, Fries P, Kramann B, Remberger K (2005) MRI of sarcomatoid carcinoma of the liver. Eur J Radiol Extra 54:63–67. doi: 10.1016/j.ejrex.2005.03.008 CrossRefGoogle Scholar
  12. 12.
    Honda H, Hayashi T, Yoshida K, et al. (1996) Hepatocellular carcinoma with sarcomatous change: characteristic findings of two-phased incremental CT. Abdom Imaging 21:37–40CrossRefGoogle Scholar
  13. 13.
    Bilgin M, Toprak H, Bilgin SS, Kondakci M, Balci C (2012) CT and MRI findings of sarcomatoid cholangiocarcinoma. Cancer Imaging 12:447–451. doi: 10.1102/1470-7330.2012.0036 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Yasutake T, Kiryu S, Akai H, et al. (2014) MR imaging of carcinosarcoma of the liver using Gd-EOB-DTPA. Magn Reson Med Sci 13:117–121. doi: 10.2463/mrms.2013-0011 CrossRefPubMedGoogle Scholar
  15. 15.
    Kojiro M, Sugihara S, Kakizoe S, Nakashima O, Kiyomatsu K (1989) Hepatocellular carcinoma with sarcomatous change: a special reference to the relationship with anticancer therapy. Cancer Chemother Pharmacol 23(Suppl):S4–8CrossRefGoogle Scholar
  16. 16.
    Shimada M, Takenaka K, Rikimaru T, et al. (2000) Characteristics of sarcomatous cholangiocarcinoma of the liver. Hepatogastroenterology 47:956–961PubMedGoogle Scholar
  17. 17.
    Hwang S, Lee SG, Lee YJ, et al. (2008) Prognostic impact of sarcomatous change of hepatocellular carcinoma in patients undergoing liver resection and liver transplantation. J Gastrointest Surg 12:718–724. doi: 10.1007/s11605-007-0393-7 CrossRefPubMedGoogle Scholar
  18. 18.
    Park HJ, Kim YK, Park MJ, Lee WJ (2013) Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma. Abdom Imaging 38:793–801. doi: 10.1007/s00261-012-9943-x CrossRefPubMedGoogle Scholar
  19. 19.
    Chong YS, Kim YK, Lee MW, et al. (2012) Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol 67:766–773. doi: 10.1016/j.crad.2012.01.004 CrossRefPubMedGoogle Scholar
  20. 20.
    Ishigami K, Yoshimitsu K, Nishihara Y, et al. (2009) Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings. Radiology 250:435–443. doi: 10.1148/radiol.2501071702 CrossRefPubMedGoogle Scholar
  21. 21.
    Eisenhauer E, Therasse P, Bogaerts J, et al. (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J cancer 45:228–247CrossRefGoogle Scholar
  22. 22.
    Yu RS, Chen Y, Jiang B, Wang LH, Xu XF (2008) Primary hepatic sarcomas: CT findings. Eur Radiol 18:2196–2205. doi: 10.1007/s00330-008-0997-7 CrossRefPubMedGoogle Scholar
  23. 23.
    Pua U, Low SC, Tan YM, Lim KH (2009) Combined hepatocellular and cholangiocarcinoma with sarcomatoid transformation: radiologic-pathologic correlation of a case. Hepatol Int 3:587–592. doi: 10.1007/s12072-009-9150-1 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Koo HR, Park MS, Kim MJ, et al. (2008) Radiological and clinical features of sarcomatoid hepatocellular carcinoma in 11 cases. J Comput Assist Tomogr 32:745–749. doi: 10.1097/RCT.0b013e3181591ccd CrossRefPubMedGoogle Scholar
  25. 25.
    Hung Y, Hsieh TY, Gao HW, Chang WC, Chang WK (2014) Unusual computed tomography features of ruptured sarcomatous hepatocellular carcinoma. J Chin Med Assoc 77:265–268. doi: 10.1016/j.jcma.2014.02.006 CrossRefPubMedGoogle Scholar
  26. 26.
    Idobe-Fujii Y, Ogi N, Hosho K, et al. (2006) Hepatocellular carcinoma with sarcomatous change arising after eradication of HCV via interferon therapy. Clin Imaging 30:416–419. doi: 10.1016/j.clinimag.2006.07.004 CrossRefPubMedGoogle Scholar
  27. 27.
    Inoue Y, Lefor AT, Yasuda Y (2012) Intrahepatic cholangiocarcinoma with sarcomatous changes. Case Rep Gastroenterol 6:1–4. doi: 10.1159/000335883 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Giunchi F, Vasuri F, Baldin P, et al. (2013) Primary liver sarcomatous carcinoma: report of two cases and review of the literature. Pathol Res Pract 209:249–254. doi: 10.1016/j.prp.2013.01.005 CrossRefPubMedGoogle Scholar
  29. 29.
    Haratake J, Yamada H, Horie A, Inokuma T (1992) Giant cell tumor-like cholangiocarcinoma associated with systemic cholelithiasis. Cancer 69:2444–2448CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Kyo-won Gu
    • 1
  • Young Kon Kim
    • 1
    Email author
  • Ji Hye Min
    • 1
  • Sang Yun Ha
    • 2
  • Woo Kyoung Jeong
    • 1
  1. 1.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Pathology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

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