Morphologic and Immunohistochemical Features of Sarcomatoid Hepatocellular Carcinoma
Thuy Nguyen, Michael Torbenson, Tsung-Teh Wu, Dhanpat Jain, Matthew Yeh, Nafis Shafizadeh, Sanjay Kakar. University of California San Francisco, San Francisco, CA; Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Yale, New Haven, CT; University of Washington, Seattle, WA; Southern California Permanente Medical Group, Woodland Hills, CA
Background: Sarcomatoid hepatocellular carcinoma (SHCC) is a rare histologic subtype of hepatocellular carcinoma. The expression of newly available epithelial, hepatocellular and progenitor cell-related markers in the sarcomatoid component is not known.
Design: Immunohistochemistry was done on 13 SHCC cases from 12 patients using the following markers:(a)Hep Par 1(Hep),polyclonal CEA (pCEA),glypican-3(GPC),arginase-1(Arg),alpha-fetoprotein(AFP) (b) Epithelial: Pankeratin (CK), MNF116, MOC31, CK7, CK19,EMA, (c)Putative progenitor cell markers: CD56, CD117,(d)Mesenchymal: vimentin, S-100, smooth muscle actin (SMA), desmin, myogenin. The staining intensity was recorded on a scale of 0-3; 2+ or 3+ staining in >10% of tumor cells was considered positive.
Results: The age range was 46-85 years (mean 62); male-to-female ratio was 2.7:1. Cirrhosis was present in 6 (50%) cases (2 hepatitis C, 2 alcoholic, 2 nonalcoholic steatohepatitis). Hepatitis C without cirrhosis was present in 3 cases;no liver disease was seen in the remaining 3 cases. Serum AFP was elevated in 50% of cases. The outcome was available for 8 cases;all patients died within one year of diagnosis. All cases had typical HCC and sarcomatoid components.HCC component was poorly differentiated in 9 (69%) cases. Sarcomatoid component was spindle cell in 8 cases (4 low, 2 intermediate, 2 high-grade), epithelioid in 1 (high grade), mixed epithelioid and spindle in 4 (1 low, 1 intermediate, 2 high-grade). There was 1 rhabdomyosarcoma, 1 leiomyosarcoma, rest were undifferentiated sarcomas. Arg was positive in sarcomatoid area in 1 case; all other hepatocellular and progenitor cell-related markers were negative. CK (92%) and MNF116 (72%) were positive in majority of cases; MNF116 positivity was more diffuse compared to CK in most cases. Other epithelial markers were negative.
Conclusions: SHCC is an aggressive subtype of HCC. Most cases show undifferentiated spindle cell morphology. Hepatocellular and progenitor cell markers are negative except rare Arg positive cases. Vimentin, CK and MNF116 are positive in most cases. The more diffuse staining with MNF116 suggests that it can be useful addition to CK to demonstrate epithelial differentiation in SHCC in needle biopsies.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 190, Tuesday Morning