Sarcomatous change of hepatocellular carcinoma in a patient undergoing living donor liver transplantation.

In a 53-year-old male who received a right liver graft from his son, computed tomography 1 week before living donor liver transplantation (LDLT) revealed three hepatocellular carcinoma (HCC) tumors in the liver that met the Milan criteria. Resected specimen revealed four tumors and microscopically, one of four HCC tumors in the resected whole liver comprised a glandular structure with spindle-like cells indicative of a sarcomatous change in HCC. Two hundred and sixty days after LDLT, the patient complained of left meralgia, which was diagnosed as iliac bone metastasis from HCC. Over a period of 3 months, the iliac bone metastasis rapidly enlarged. The tumor aggressively extended into the patient's bone marrow, causing severe pancytopenia. The patient died 371 days after LDLT. This tumor was detected preoperatively by computed tomography but lack of enhancement. These findings indicate that pathologic evaluation of each tumor is a key to predicting an accurate prognosis.