HILLCREST MODEL

HILLCREST MODEL



HILLCREST MODEL

History and Physical

A 72-year-old man named John Gigs was found to have a 40 mm mass in liver segment VIII during follow-up abdominal ultrasonography for type C viral hepatitis at a local hospital, and he was therefore admitted to CTCA cancer hospital. He had no annals of body-fluid transfusion or alcoholism. Laboratory data demonstrated that his serum grades of total protein, total bilirubin, alkaline phosphatase and alpha-fetoprotein were inside normal limits, but the serum grades of aspartate aminotransferase (50 IU/ml), alanine aminotransferase (74 IU/ml) and protein induced by the vitamin K absence or antagonist II (46 mAU/ml) were elevated. Serum markers for hepatitis B were negative.

Consultation 1

Abdominal ultrasound disclosed a well-defined, mosaic-patterned mass, 40 mm in diameter, encompassing a cystic component, in liver segment VIII (Fig. 1A). Abdominal angiography displayed a ring-like heterogeneous tumor stain with arterial neovascularity. The tumor emerged as a perfusion defect on computed tomography (CT) throughout arterial portography and displayed assessed enhancement at the periphery on CT hepatic arteriography, the centered piece being visualized as heterogeneous hypoattenuation (Fig. 1B). Under a pre-operative diagnosis of atypical HCC with centered necrosis, partial resection of liver segment VIII was performed. At present, 30 months after surgery, the persevering remains well without any clues of tumor recurrence.

Consultation 2

Primary hepatic carcinosarcoma is defined as a malignant tumor containing an intimate mixture of carcinomatous (either hepatocellular or cholangiocellular) and sarcomatous elements (Ikebe 1998). This neoplasm is very uncommon, and only 20 preceding cases have been described in the English literature. Here, we recount an added case, in which it was possible to immunohistochemically illustrate both the carcinomatous and the sarcomatous constituents. This neoplasm has a considerably poorer prognosis than hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC), being affiliated with a high frequency of early metastasis. The present case was encountered a patient who underwent surgical resection for prime hepatic carcinosarcoma. This persevering has endured without recurrence for 30 months, which is the longest disease-free time span amidst before described situations of hepatic carcinosarcoma. The tumor was composed of an HCC constituent in its external locality and an osteosarcoma constituent in its interior locality, displaying histological transition between the two areas. Since the tumor was little in dimensions and displayed a concentric growth pattern of carcinoma and sarcoma, which appears to be a very uncommon production of somewhat early-stage hepatic carcinosarcoma, and the patient displayed extended survival.

Figure 1.

(A) Abdominal ultrasound image displays a well-defined mass with a cystic constituent (*) in segment VIII of the liver. The solid constituent displays a heterogeneous area with a mosaic pattern (white arrowhead). (B) Computed tomography hepatic arteriography shows a well-defined tumor consisting of a marginal well-enhanced locality (black arrowhead) with an internal poorly enhanced locality (**) and a cystic locality (*).

Pathological and Radiological Findings

Macroscopically, the resected tumor measured 4.5 × 3.8 × 3.5 cm. Its slash exterior displayed a yellowish-white, elastic-hard solid constituent in the peripheral locality, and a cavity structure in the central locality with degenerated and necrotic tissue containing dark ...