A case report of combined hepatocellular and cholangiocellular carcinoma with sarcomatous change that rapidly recurred to peritoneal dissemination after hepatectomy

We report a case of combined hepatocellular and cholangiocellular carcinoma with sarcomatous change that rapidly recurred in peritoneal dissemination after hepatectomy. A 58-year-old man referred for a liver mass was found in dynamic computed tomography (CT) and abdominal angiography to have a tumor with a diameter of 3cm not similar to hepatocellular carcinoma. Needle biopsy yielded a diagnosis was moderately differentiated hepatocellular carcinoma necessitating right hepatectomy of the liver. The 4. 0 × 3. 3 × 3. 2 cm tumor was an elastic hard, clear nodule without a capsule. Histologicaly it was combined hepatocellular and cholangiocellular carcinoma. On postoperative day (POD) 60, he was readmitted for abdominal distension and appetite loss. Abdominal CT showed peritoneal dissemination and accumulated ascites, cytological class V. After admission, his condition worsened rapidly and he died on POD 77 of peritoneal dissemination and peritonitis carcinomatosa. Microscopic findings of peritoneal dissemination on autopsy showed spindle cells and strange proliferated cells with a sarcomatous pattern. We believe these sarcomatous changes caused the rapid clinical course.