Abstract
Background
Hepatic sarcomatoid carcinoma (HSC) and hepatic sarcoma (HS) are rare malignancies. Without pathology, the differential diagnosis between these two tumors are difficult due to their frequent overlaps in clinical presentations and imaging features. Currently, there are limited analyses about the ultrasound (US), contrast-enhanced ultrasound (CEUS) and contrast-enhanced computer tomography (CECT) characteristics of HSC and HS. Therefore, the purpose of our study is to evaluate the value of US, CEUS and CECT on the differential diagnosis between HSC and HS.
Methods
From 2015 to 2022, a total of 23 patients with HSC (n = 11) and HS (n = 12) are included in this retrospective study. We analyze the clinical, pathological, and imaging data of these patients. Analysis of differences is performed to determine the consistent and distinctive features.
Results
HSCs have a considerably higher prevalence of chronic hepatitis (p = 0.005) and cirrhosis (P = 0.027) than HSs, while metastases are more prevalent in HSs (P = 0.005). The lesion size of HSCs (8.1 ± 2.2 cm) is slightly larger than that of HSs (6.2 ± 3.4 cm). On conventional US, the characteristics of HS and HSC are similar. On CEUS, HSC can be differentiated from HS by heterogeneous rim-like enhancement with necrotic zone during arterial phase (AP). Notably, for different pathological types of HS, the presence of enhancement in AP on CECT can be used to distinguish hepatic fibrosarcoma from hepatic liposarcoma.
Conclusion
HSC and HS generally present as masses with hypo-echoic and hypo-vascularity. HSC usually presents heterogeneous density. The degree of enhancement, the time of wash-out start, and the presence of necrotic areas may contribute to distinguish the different pathological types of HS.