Comparative analysis of clinical manifestations and MRI features between hepatocellular carcinoma and sarcomatoid hepatocellular carcinoma

Abstract

Abstract: Objective To investigate the clinical manifestations and magnetic resonance imaging (MRI) features of sarcomatoid hepatocellular carcinoma (SHCC) and hepatocellular carcinoma (HCC), and to provide valuable data for differential diagnosis of SHCC. Methods A total of 12 patients (10 males and 2 females) with SHCC admitted to our hospital from January 2010 to June 2021 were enrolled, with an average age of (59.4 ± 11.7) years. Meanwhile, 30 cases of HCC in the same period were included as control group. The clinical manifestations and MRI features of SHCC and HCC patients were compared. T-test and chi-square test were used for comparison. Results The incidence rates of clinical symptoms in SHCC and HCC patients were 9 (75.0%) and 8 (26.7%), the difference was statistically significant (χ²=8.311, P<0.05). In SHCC group, there were 6 cases (50.0%) with hepatitis B virus (HBV) infection and 28 cases (93.3%) with chronic liver disease, which were significantly different from control group [28 cases (93.3%) and 28 cases (93.3%)] (χ²=-10.438, -7.560, P<0.05). The numbers of stage I/II, III/IV in SHCC group were 2 cases (16.7%) and 10 cases (83.3%), which were significantly different from those in control group [19 cases (63.3%) and 11 cases (36.7%)] (χ²=-7.467, P<0.05). In SHCC group, carcinoma antigen 125 (CA125), carcinoma antigen 199 (CA199) and carcinoma embryonic antigen (CEA) increased in 5 cases (41.7%), 4 cases (33.3%) and 3 cases (25.0%), which were significantly different from control group[0 (0), 0 (0) and 0 (0)] (χ²=14.189, 11.053, 8.077, P<0.05). The MRI features of SHCC patients were tumor diameter in (6.1±1.3) cm, 6 (50.0%) with cholangiectasis and 5 (41.7%) with pseudocapsule, which were significantly different from control group [(4.2 ± 1.0) cm, 2 (6.7%) and 25 (83.3%)] (t=7.308, χ²=10.438, -7.292, P<0.05). In SHCC group, "fast-forward and fast-out", continuous enhancement, peripheral enhancement, gradual enhancement, recession and insufficient blood supply were 0 (0), 4 (33.3%), 0 (0), 7 (58.3%), 0 (0) and 1 (8.3%), which were significantly different from control group [28 cases (93.3%), 1 cases (3.3%), 0 (0), 1 case (8.3%) and 0 (0)] (χ²=-36.925, P<0.05). There were 5 cases (41.7%) with intrahepatic metastasis and 4 cases (33.3%) with lymph node enlargement in SHCC group, which were significantly different from control group [4 cases (13.3%) and 1 case (3.3%)] (χ²=4.087, 7.356, P<0.05). Conclusion Clinical symptoms such as abdominal pain, fatigue, fever and jaundice are common in patients with SHCC, and serum tumor markers including CA125, CA199, CEA are abnormally elevated. In addition, false capsule, progressive/continuous enhancement, intrahepatic metastasis and lymph node enlargement are typical MRI features of patients with SHCC. The manifestations above-mentioned will contribute to the differential diagnosis of SHCC.

Key words: Sarcomatoid hepatocellular carcinoma, Hepatocellular carcinoma, Magnetic resonance imaging enhancement mode

WANG Qi-hang, GUO Yong-bang. Comparative analysis of clinical manifestations and MRI features between hepatocellular carcinoma and sarcomatoid hepatocellular carcinoma[J]. Chinese Hepatolgy, 2022, 27(9): 983-985.

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