P1830 - Hepatic Carcinosarcoma: A Hydra-Headed Foe That May Require Simultaneous Attacks

Zeyad Sako, MD, Wei Zhao, MD, Zyad Kafri, MD, Aditi Singh, MD
St. John Hospital and Medical Center, Grosse Pointe Woods, MI

Introduction: Hepatic carcinosarcoma is a rare malignancy a mixture of carcinomatous and sarcomatous cells. Compared to hepatocellular carcinoma (HCC), hepatic carcinosarcoma has significantly worse prognosis with median survival time of less than one year. We are presenting a case of hepatic carcinosarcoma treated with locoregional transarterial chemoembolization (TACE) and systemic chemotherapy.

Case Description/Methods: A 71-year-old African American male presented with progressively worsening right upper quadrant abdominal pain for 3 weeks. He characterized his abdominal pain as constant dull pain that was exacerbated by eating. He also reported nausea, vomiting and unintentional weight loss of 20 lbs. over the past 4 weeks. Serum alpha-fetoprotein, a tumor marker for HCC, was markedly elevated at more than 60500 ng/mL. Hepatitis B surface antigen, total hepatitis B core antibody and hepatitis C antibody were negative. Abdominal MRI with and without contrast revealed a 11.8 x 19 x 10.3 cm mass containing hemorrhagic and necrotic components in the left lobe of liver. Delayed washout of contrast media, however, opposed to the typical finding of HCC. CT-guided tumor biopsy displayed two distinct populations: hepatocellular carcinomatous cells positive for Hep-Par-1, arginase, cytokeratin CAM 5.2 and glypican-3, and sarcomatous spindled cells positive for vimentin. This finding was consistent with hepatic carcinosarcoma. His Child-Turcotte-Pugh Score was 6, putting him under class A. Patient was deemed inoperable due to inadequate future liver remnant. We proceeded to perform TACE of the left hepatic lobe mass supplied by left hepatic artery utilizing doxorubicin-eluting beads. The repeat angiography demonstrated satisfactory results. This was followed by systemic chemotherapy using doxorubicin and cisplatin. His clinical course has been uneventful till now 3 months after diagnosis.

Discussion: The optimal treatment for hepatic carcinosarcoma remains undetermined due to the rarity and heterogeneity of this entity. Single approach with either locoregional liver-directed therapy or systemic chemotherapy was associated with rapid deterioration in patients with unresectable tumor. By analogy with the multi-headed monster Hydra defeated by knife and fire together, hepatic carcinosarcoma may benefit from multimodal treatment, which simultaneously targets carcinomatous and sarcomatous components, as well as local and metastatic sites.


Disclosures:


Zeyad Sako, MD, Wei Zhao, MD, Zyad Kafri, MD, Aditi Singh, MD. P1830 - Hepatic Carcinosarcoma: A Hydra-Headed Foe That May Require Simultaneous Attacks, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.