case_images: PMC10585252_01
case_images: Representative computed tomography images showing changes in the tumor throughout the treatment period prior to surgery. (A) perihepatic tumor with blurred edges in the right liver at initial diagnosis. (B) extrahepatic tumor growth (with a blurred boundary) covering the upper pole of the right kidney, 2 months after transcatheter arterial chemoembolization. (C) stable tumor size and clear boundary after treatment with tyrosine kinase inhibitors and anti-PD-1 antibodies for 6 months.
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case_images: Enhanced computed tomography (CT) revealed the presence of liver cirrhosis with a tumor in the right lobe of the liver that measured 86.0 mm x 75.0 mm x 71.0 mm and was considered to be malignant ( Figure 1A ). However, enhanced CT showed enlargement of the tumor (in the right lobe of the liver), which now measured 123.0 mm x 90.0 mm x 89.0 mm ( Figure 1B ). In addition, the boundary between the tumor and the surrounding tissue, both inside and outside the liver, had become more distinct ( Figure 1C ).
case_images: Hematoxylin-eosin staining of needle puncture biopsy and resected specimens. (A) original magnification of 100x and 400x in puncture biopsy specimen. (B) original magnification of 100x and 400x in resected specimen.
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case_images: Ultrasound-guided needle biopsy of the tumor demonstrated a pathological diagnosis of hepatic malignancy in favor of a sarcoma or sarcomatoid carcinoma ( Figure 2A ). A diffuse, patchy, invasive growth was seen that had destroyed the surrounding liver tissue; examination also showed vacuolated nuclei, visible eosinophilic nucleoli, interstitial hyaline changes, necrosis of tumor cells, rare instances of nuclear fission, and small foci of hyperplasia in the bile ducts ( Figure 2B ).
case_images: Surgical field and resected specimen. (A) surgical field after resection of the tumor. The white arrow shows the section of the right liver, the blue arrow indicates the sutured and repaired right diaphragm, and the yellow arrow shows the naked upper pole of the right kidney after resection of the perirenal fat sac. (B) resected specimen of the right liver. (C) resected specimen of the right diaphragm and tissues around the upper pole of the right kidney.
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case_images: The liver tumor was removed completely in addition to part of the right diaphragm and right perirenal fat sac that were attached to the tumor ( Figure 3 ).
case_images: Timeline of treatment course.
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case_images: The timeline of the course of treatment is shown in  Figure 4 .
case_images: Immunohistochemistry of spindle cells in the resected specimen (A-C) show positivity for CK, CK19, and beta-catenin. (D) shows Ki-67 positivity in approximately 40% of cells.
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case_images: On immunohistochemistry, the spindle cells tested positive for cytokeratin (CK), CK19, integrase interactor 1, leukocyte common antigen, and beta-catenin and Ki-67 positivity was observed in approximately 40% of cells ( Figure 5 ); however, they tested negative for cluster of differentiation (CD) 30, caudal type homeobox-2, carcinoembryonic antigen, CK7, CK20, isocitrate dehydrogenase-1, and tumor protein 53.