Sarcomatoid Variant of Hepatocellular Carcinoma: Rare and Deadly

Sarcomatoid hepatocellular carcinoma (SHCC) is a rare and aggressive subtype of hepatocellular carcinoma (HCC), often associated with poor prognosis due to its late presentation, high metastatic potential, and resistance to treatment. We report the case of a 69-year-old male with newly diagnosed hepatitis C infection who presented with right hypochondrial pain, weight loss, and constitutional symptoms. Imaging revealed multiple hepatic masses, portal vein thrombosis, and extensive lymphadenopathy. Biopsy of a dominant liver lesion confirmed SHCC, with histopathological features of atypical spindle cells and immunohistochemical positivity for cytokeratin (CK), glutamine synthetase, and heat shock protein-70 (HSP-70), confirming hepatocellular lineage. Given the unresectable nature of the disease and its advanced stage at diagnosis, the patient received doxorubicin-based chemotherapy as a palliative measure; however, despite initial symptomatic improvement, the overall survival was limited to 5.5 months from the time of initial presentation. This case highlights the diagnostic and therapeutic challenges of SHCC and underscores the importance of early histological confirmation, as well as the urgent need to explore novel systemic therapies for this condition.