SARCOMATOUS HEPATOCELLULAR-CARCINOMA WITH MALIGNANT ASCITES - A REPORT OF 2 CASES

BACKGROUND: Although some cases of hepatocellular carcinoma (HCC) ave known to possess a sarcomatous appearance their cytologic characterist ics in ascites have not been reported. CASES: Two Japanese males, aged 67 and 60, were admitted to the Gifu Municipal Hospital because of li ver tumors. In the first case, although transcatheter arterial emboliz ation (TAE) was performed, ascites with neoplastic cells continued to enlarge, and the patient died of liver failure. In the second case, al though TAE, percutaneous ethanol injection therapy, chemotherapy and r adiotherapy were performed, the pa tient died of tumor progression: ex pansion of the hepatic tumor, metastases to distal organs and increasi ng malignant ascites. Neoplastic cells in the ascites of both cases ha d nuclei that were shaped irregularly or were vesicular and contained conspicuous nucleoli. A number of multinucleated giant cells were also seen. Immunocytochemically, numerous neoplastic cells were positive f or alpha-fetoprotein. These findings suggested sarcomatous HCC. Also, histologic findings of the liver tumors at all topsy showed the appear ance of sarcomatous HCC. CONCLUSION: In both cases presented, HCC cell s with sarcomatous change were observed in ascites. To our knowledge, this is the first report describing the cytologic diagnosis of sarcoma tous HCC in ascites.