P3995 - Not All Liver Cancers Are Carcinomas – A Primary Liver Sarcoma in an Adult

Chinmay Trivedi, MD, Nazir Ahmed, MD, Shawn Philip, DO, Kunchang Song, MD, John Sotiriadis, MD, PhD
Hackensack Meridian Palisades Medical Center, North Bergen, NJ

Introduction: The vast majority of all primary hepatic cancers belong to the carcinoma subtype and sarcomas only represent around 2% of them. Despite being a common malignant soft tissue tumor, undifferentiated pleomorphic sarcomas (UPS) rarely involve the liver. We report an interesting case of high-grade hepatic UPS.

Case Description/Methods: A 45-year-old male with a self-reported history of hepatitis B as a child presented with worsening abdominal discomfort and a persistent enlarging upper abdominal mass for more than a month. This was associated with decreased appetite and a 40 lbs. weight loss. He denied alcohol abuse, smoking or illicit drug use. His vitals were normal except for sinus tachycardia. On physical exam, the patient was cachectic and had a firm, non-tender epigastric mass. CT and MRI of the abdomen revealed a large lobulated hypo-attenuating left hepatic lobe mass with central necrosis measuring 22 x 15.3 x 13.9 cm with tumor thrombus in the left hepatic vein extending into the inferior vena cava. AFP, CEA, and CA-19-9 levels were within normal range. Hepatitis B and C serologies were negative. Liver biopsy pathology demonstrated high-grade pleomorphic undifferentiated sarcoma. He underwent IR bland embolization and was subsequently discharged with outpatient oncology follow-up. He is currently undergoing combination chemotherapy with gemcitabine and docetaxel.

Discussion: Primary liver sarcoma is not associated with the conventional risk factors known to cause hepatocellular carcinoma. This case highlights the importance of a prompt tissue diagnosis being pivotal, in all liver cancers which do not fall under the conventional clinical and lab features of hepatocellular carcinoma, for appropriate and timely management.



Disclosures:


Chinmay Trivedi, MD, Nazir Ahmed, MD, Shawn Philip, DO, Kunchang Song, MD, John Sotiriadis, MD, PhD. P3995 - Not All Liver Cancers Are Carcinomas – A Primary Liver Sarcoma in an Adult, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.