Pancoast syndrome due to pulmonary metastasis of sarcomatoid hepatocellular carcinoma

Keywords: Hepatectomy, Pancoast syndrome, sarcoma INTRODUCTION Primary liver cancer is the fifth most common prevalent cancer and the third commonest cause of cancer-attributed mortality.1 Hepatocellular carcinoma (HCC) is the principal histological type of liver cancer and accounts for about 75% of liver cancers.2 Sarcomatoid hepatocellular carcinoma (SHC) is a rare form of HCC comprising of epithelial cells and mesenchymal spindle cells which makes up for about 1.8-3.9% of HCC cases.3 The most common site of metastasis for HCC is the lung4, and SHC metastasis to the lung is also reported.5 Despite the prevalence of liver cancer metastasis to the lung, according to our research there are only four Pancoast syndrome reports from primary HCC related pulmonary metastases, and none from SHC69 In this case report, a patient with known history of SHC presented with symptoms of Pancoast Syndrome due to pulmonary metastasis of SHC 5 months after hepatic resection. The standardised liver volume based on 62.0 kg body weight was 1047.0 ml. [...]residual liver volume to standardised liver volume ratio was 52.1%. Sarcomatoid change in HCC is defined as "sarcomatous HCC" in the World Health Organization (WHO) classification.10 The diagnosis of SHC should be made when a sarcomatous component consisting of malignant spindle cells11 is present within a conventional HCC. SHC cases have been reported after anticancer therapy of HCC such as transcatheter arterial chemoembolisation (TACE), radiofrequency ablation (RFA), or percutaneous ethanol injection as these therapies may speed up proliferation of sarcomatous cells."¦13 SHC is also associated with Hepatitis B and Hepatitis C infections.14 In many instances the diagnosis of SHC is made after surgical resection, and pre-operative diagnosis by MRI and CT scan imaging lacks sensitivity.15 In our patient, the sarcomatoid component consisted of malignant spindle cells that merged with areas of conventional HCC.