Sarcomatoid cholangiocarcinoma with osteoclast-like giant cells associated with hepatolithiasis: A case report

• Published in: Clinical and molecular hepatology Vol. 21; no. 3; pp. 309 - 313
• Main Authors: Kim, Hye Min, Kim, Haeryoung, Park, Young Nyun
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of the Liver 01.09.2015; The Korean Association for the Study of the Liver
• Subjects: Aged; Antigens; Antigens, CD - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; Bile ducts; Cadherins - metabolism; Cholangiocarcinoma; Cholangiocarcinoma - diagnostic imaging; Cholangiocarcinoma - pathology; Cholangitis; Cytokeratin; Epidemiology; Female; Genotype & phenotype; Giant Cells - diagnostic imaging; Giant Cells - metabolism; Giant Cells - pathology; Hepatitis; Humans; Liver cancer; Liver Pathology; Medical prognosis; Metastasis; Osteoclast-like giant cells; Osteoclasts - pathology; Pathology; Sarcomatoid cholangiocarcinoma; Tomography, X-Ray Computed; Transcription factors; Tumors; Pathology; Sarcomatoid cholangiocarcinoma; Osteoclast-like giant cells
• ISSN: 2287-2728; 2287-285X
• DOI: 10.3350/cmh.2015.21.3.309

A computed tomography scan was performed to evaluate the cause of abdominal pain, and revealed distal common bile duct stone or sludge with dilatation of the common bile duct and bilateral intrahepatic ducts and a 6 cm-sized heterogeneous lobulated mass in the left lateral segment of the liver, suggestive of intrahepatic CC with multiple left intrahepatic duct stones (Fig. 1A, B). Transforming growth factor β as well as transcription factors such as Twist, Snail, Slug, Sip1, ZEB1 and ZEB2 have a regulatory role in EMT.7 Also, increased uPAR expression has been implicated in the promotion of EMT in various cancers.8 Previous report about 27 cases of sarcomatoid carcinoma originating from various organs, mostly from gastrointestinal tract which included 4 cases of CCs demonstrated that most sarcomatoid carcinomas express EMT-related markers such as Twist1, Snail1, Slug, Sip1 and ZEB1.9 Presenting case showed a positive expression for EMT-related markers: vimentin, uPAR, and loss of E-cadherin, suggesting of EMT. Another sarcomatoid carcinoma primarily occurring in the liver is sarcomatoid hepatocellular carcinoma (HCC), and 73 cases of sarcomatoid HCC have been reported in the English literature in the past 20 years.10 Preoperative anticancer treatment such as transcatheter arterial chemoembolization, radiofrequency ablation or percutaneous ethanol injection has been reported to be associated with sarcomatous change in HCC.11 Sarcomatoid HCC without previous therapies was also reported, although there are only a few reports of such cases.12 The present patient with sarcomatoid CC had no history of preoperative treatment, therefore, preoperative treatment is not considered to be necessary for the sarcomatoid change. Clinically, hepatolithiasis is considered as a main cause of CC in Korea16 and approximately 10% of patients with hepatolithiasis develop CC.17 Repeated episodes of cholangitis due to hepatolithiasis are considered to induce proliferative epithelial changes and accelerate tumorigenesis.18 The prognosis of CC is generally unfavorable because of frequent metastasis, low resectability rate and high incidence of recurrence even after curative resection.