A Case of Hepatic Carcinosarcoma with Bile Duct Tumor Thrombi

Kosuke Endo, Hiroaki Terajima, Yukihiro Imai¹⁾, Kyo Ito²⁾, Yasuhiro Ogura, Michihiko Wada and Ryo Hosotani

Department of Surgery, Department of Pathology¹⁾ and Department of Radiology²⁾, Kobe City General Hospital

A 67-year-old man referred for jaundice was found in computed tomography to have an enhanced band-shaped tumor in segment 5 and bile duct tumor thrombi causing dilation of intrahepatic bile ducts. Percutaneous transhepatic cholangial drainage tube cholangiography showed tumor thrombi extending from the anterior segment branch into the left hepatic duct and the common bile duct. Brushing cytology of the bile duct suggested adenocarcinoma, while histological diagnosis of the tumor thrombus biopsy was sarcoma. Based on a preoperative diagnosis of intrahepatic cholangiocarcinoma or hepatic sarcoma, we conducted central bisegmentectomy with biliary reconstruction. Histopathological findings showed a combined structure of well-differentiated adenocarcinoma with clear cytoplasm and spindle-cell sarcoma with poorly formed cytoplasm. Sarcomatous components included chondrosarcoma and osteosarcoma, leading to the final diagnosis of hepatic carcinosarcoma. The man remains alive without recurrence 16 months postoperatively. Hepatic carcinosarcoma is rare, and this is, to our knowledge, the first case report of hepatic carcinosarcoma with bile duct tumor thrombi.

Key words
hepatic carcinosarcoma, bile duct tumor thrombus, mixed malignant hepatic tumor

Reprint requests
Kosuke Endo Department of Surgery, Kobe City General Hospital
4-6 Minatojimanakamachi, Chuo-ku, Kobe, 650-0046 JAPAN

Accepted
June 27, 2007

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