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1 Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis after hepatic resection have yet to be clarified. The purpose of this study was to analyze the outcome of sarcomatous HCC patients who underwent surgical resection. Methods: From January 1997 to May 2005, 11 patients (1.1%) were diagnosed with sarcomatous HCC among 1,005 cases of HCC undergoing resection after pathology and immunohistochemical studies. Results: All of the cases were male and their mean age was 55.8±8.1 years. R0 resection was achieved in nine of the 11 patients. The HCC lesions were classified as stage II in three, stage III in four, stage IVa2 in three, and IVb in one, according to the modified ptnm staging system. Extrahepatic metastases as the initial recurrence occurred in eight patients. Among the 11 patients, 10 died of a disease recurrence and only one is still alive. The overall 3-year survival rate was only 18%. Conclusions: The prognosis of sarcomatous HCC was very poor, showing widespread extrahepatic metastases and frequent early recurrence regardless of the tumor extent. Since some patients showed prolonged survival after a local recurrence, vigorous postoperative systemic surveillance appears to be beneficial for early detection and timely treatment of localized metastases.

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5 Diagnostic problems for the surgical pathologist. Pathology 1994;3: Hepatocellular carcinoma with sarcomatous change: a special reference to the relationship with anticancer therapy. Cancer Chemother Pharmacol 1989;23 Suppl:S4-8. Hepatocellular carcinoma with sarcomatous change. Clinicopathologic and immunohistochemical studies of 14 autopsy cases. Cancer 1987;59: Spindle cell hepatocellular carcinoma. A clinicopathologic and immunohistochemical analysis of 15 cases. Cancer 1996;77: Carcinosarcoma of the liver: a case report and review of the literature. Arch Pathol Lab Med. 2005;129: A case with

6 sarcomatoid hepatocellular carcinoma. Yonsei Med J 1998;39: A randomized prospective multi-institutional trial of orthotopic liver transplantation or partial hepatic resection with or without adjuvant chemotherapy for hepatocellular carcinoma. Investigator booklet and protocol, Immunohistochemical and molecular markers in the diagnosis of hepatocellular carcinoma. Adv Anat Pathol 2004;11: An autopsy case of hepatic sarcomatoid tumor: immunohistochemical comparison with a sarcomatous component of hepatocellular carcinoma. Pathol Int 1994;44: Sarcomatous hepatocellular carcinoma: a special reference to ordinary hepatocellular carcinoma. J Gastroenterol Hepatol 2003;18: Clinicopathologic analysis of stage II-III hepatocellular carcinoma showing early massive recurrence after liver resection. J Gastroenterol Hepatol 2000;15: Hepatocellular carcinoma with sarcomatous change arising after radiofrequency ablation for well-differentiated hepatocellular carcinoma. Hepatol Res 2003;27: Hepatocellular carcinoma with sarcomatous change arising in primary biliary cirrhosis. J Gastroenterol 1997;32: Unusual liver carcinomas with sarcomatous features: analysis of four cases. Surg Today 2001;31: Hepatocellular carcinoma with sarcomatous change arising after eradication of HCV via interferon therapy. Clin Imaging 2006;30: Hepatocellular carcinoma containing sarcomatous lesions in a normal liver, accompanied by secondary Budd-Chiari syndrome. J Clin Gastroenterol 2004;38: A case of sarcomatoid hepatocellular carcinoma in a young female without risk factor. Korean J Gastroenterol 2006;47: Hepatocellular carcinoma with sarcomatous proliferation showing an unusual and wide-spread metastasis. Acta Pathol Jpn 1984;34: Clinicopathologic study on lymph node metastasis of hepatocellular carcinoma: a retrospective study of 660 consecutive autopsy cases. Jpn J Clin Oncol 1994;24: Dual-tracer PET/CT imaging in evaluation of metastatic hepatocellular carcinoma. J Nucl Med 2007;48: Positron emission tomography/computer tomography: challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies. World J Gastroenterol 2007;13: Hepatocellular carcinoma with a sarcomatous appearance: report of a case. Surg Today 2001;31:

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