A Case of Hepatocellular Carcinoma with Sarcomatous Change Showing Rapid Recurrence in Pleural Dissemination after Hepatectomy

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We report a case of hepatocellular carcinoma with sarcomatous change that rapidly recurred in pleural dissemination after hepatectomy. A 61-year-old man was diagnosed as having a hepatic mass. Hepatocellular carcinoma accompanied by multiple intrahepatic metastases was diagnosed based on computed tomography and magnetic resonance imaging. Extended right hepatic lobectomy under thoracolaparotomy was performed after portal vein embolization. Forty days after hepatectomy, the patient was complicated with massive pleural effusion. Thoracoscopy showed diffuse irregular thickened pleura, in which, spindle cells positive for Vimentin, Keratin and EMA were demonstrated. Same type spindle cells were recognized around hepatocellular carcinoma in the liver. Final diagnosis of hepatocellular carcinoma with sarcomatous change was made. The patient died 56 days after hepatectomy. Close follow-up is needed in cases of hepatocellular carcioma with sarcomatous change, because the carcinoma has a strong potential for recurrence such as dissemination.