• Qianru Gu, Xia Yu, Hanbin Chen, and Guorong Chen.
• Department of pathology, First Affiliated Hospital of Wenzhou Medical University, Ouhai, Wenzhou, People's Republic of China.
• Medicine (Baltimore). 2018 Jan 1; 97 (3): e9640e9640.

RationaleCombined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare subtype of primary liver malignancy comprising <1.5% of all primary liver tumors. Sarcomatoid changes in cHCC-CC are even rarer. Due to the rarity of this subtype, its clinicopathological feature is poorly understood. Therefore, here we report 2 tumors.Patient ConcernsThe first patient was a 44-year-old man with 5-year history of hepatitis B-induced cirrhosis. The resection of right liver revealed a 2.5 × 2.5 × 2 cm tumor mass. Histologically, the tumor showed areas of the typical moderately differentiated HCC. An intermingled adenocarcinoma with pleomorphic and spindle-shaped cells was also identified. The second case involved a 54-year-old man with a history of hepatitis B-induced cirrhosis. A 3.5 × 3 × 3 cm mass was found in the middle left of falciform ligament. Microscopically, the tumor consisted of spindle-shaped sarcomatoid carcinoma cells mixed with typical well-differentiated HCC and well-differentiated CC.DiagnosesAccording to the clinicopathological features, diagnosis of cHCC-CC with sarcomatous change was made.InterventionsIn the first case, right lobectomy of the liver was performed. The second patient underwent laparoscopic, hepatic left lateral lobectomy.OutcomesThe first patient was alive and well 10 years after the surgical resection without additional treatment. In second case, at 8 months after surgical resection, there was no evidence of recurrence or metastasis.LessonsIn this report, we describe 2 rare cases of cHCC-CC with sarcomatous change, and findings are helpful for the pathologists would like to further identify the clinicopathological features of this rare tumor.Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

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