Spontaneous Rupture as the Initial Symptom of Primary Hepatic Carcinosarcoma: A Thorough Case Report with Follow-up Data and Literature Review

Abstract

Abstract Background Primary hepatic carcinosarcoma (HCS) is an extremely rare malignant tumor that is composed of a mixture of carcinomatous and sarcomatous elements. However, there have been few reported cases, especially with sufficient records to describe imaging and pathological features, posing the diagnosis, treatment, and prognosis of HCS significant challenges for clinical physicians. Here, we report and review a case of HCS, including combined imaging findings, analysis of pathology and immunohistochemistry, and clinical features, which will be beneficial for future diagnosis, improving clinical management, and exploring effective treatments to improve survival for HCS patients. Case presentation: Here, we report a case of HCS with spontaneous rupture as the initial symptom in a 77-year-old elderly male who was admitted with right upper abdominal pain for 8 days. The computed tomography (CT) enhancement scan revealed a massive, enhanced shadow primarily outside of the liver; hypodense fluid was seen around the liver, which was initially considered a spontaneous rupture of giant primary liver cancer. The patient underwent a laparotomy, but postoperative pathology unexpectedly showed an HCS with spontaneous rupture. Although the primary lesion was successfully removed during the surgery, the tumor recurred only 5 months after surgery and was approximately as large as the initial tumor. Unfortunately, the patient was not a candidate to undergo surgery to remove the recurrent tumor. Just 9 days after his second discharge, the patient passed away at home. His postoperative survival time was only 5 months. Conclusions HCS is an extremely rare malignant tumor with high malignancy and poor prognosis, for which there is still no effective therapy. This study demonstrates the imaging characteristics and pathological results of an HCS patient whose initial symptom was a spontaneous rupture hemorrhage and reviews the clinical features of HCS previously reported in the literature. Additional similar cases are needed to clarify the exact diagnosis, and treatment of this disease.