An autopsy case of hepatocellular carcinoma showing a sarcoma-like feature

An autopsy case of a 45-year-old male with hepatocellular carcinoma showing a predominant sarcoma-like feature was reported. The patient was a heavy-drinker and was admitted because of anorexia and abdominal distension. He died of hepatic coma 5 days after admission. Autopsy revealed a large tumor mass, measuring 7×7×5cm in size, in the left lobe of the liver and numerous nodes in both lobes of the liver, both lungs, myocardium and peritoneum. All of the tumors, except in one area, consisted of a loose proliferation of spindle-shaped or round clear cells, Which suggested spindle cell sarcoma. However, well differentiated hepatocellular carcinoma of the trabecular type was shown in a tiny area consisting of three small nodes. The transitional from between hepatocellular carcinoma and sarcoma-like feature was also seen. Immunohistochemical staining for epithelial membrane antigen (EMA) revealed EMA-positive cells in the nodes showing sarcoma-like feature. Thus it seemed that the sarcoma-like lesion was a variation or an anaplastic change of hepatocellular carcinoma, because of the presence of the transitional form and EMA in the sarcoma-like lesion.