Sarcomatoid hepatocellular carcinoma with mixed osteoclast-like giant cells and chondroid differentiation

The sarcomatoid variant of hepatocellular carcinoma (HCC) is a rare histologic variant comprising malignant spindle cells and typical HCC. The proportion of the spindle cell component varies; when the tumor fully consists of malignant spindle cells, it is difficult to distinguish from various primary sarcomas. The 2010 World Health Organization classification of gastrointestinal tract tumors classifies sarcomatoid HCC under the special HCC types with fibrolamellar carcinoma, scirrhous HCC, undifferentiated carcinoma, and lymphoepithelioma-like carcinoma. Carcinosarcoma, which is synonymously used with sarcomatoid carcinoma, is separately described under “malignancies of mixed or uncertain origin” of the liver encompassing calcifying nested epithelial stromal tumor, combined hepatocellular-cholangiocarcinoma, hepatoblastoma, mixed epithelial-mesenchymal type, and malignant rhabdoid tumor. Here a recent case of sarcomatoid HCC is reported and relevant literature is reviewed.