Sarcomatoid carcinoma of the liver with skin and pleural metastases

Sir, We report an interesting case of sarcomatoid carcinoma of the liver with skin metastases. A 53‐year‐old Japanese man with liver cirrhosis due to alcohol abuse presented with asymptomatic cutaneous nodules that had developed over a 5‐month period. Examination showed five 1·5–2‐cm reddish‐coloured hard cutaneous nodules on his face and head (Fig. 1a). He also had venous varix of the oesophagus due to liver cirrhosis, a 4‐cm tumour of the S6 segment of the liver (Fig. 2a), and osteolytic lesions of the left pelvis and the right small trochanter, which strongly suggested metastasis. Laboratory tests showed liver dysfunction (aspartate aminotransferase 46 U L−1, alanine aminotransferase 41 U L−1, γ‐glutamyltransferase 106 U L−1), leucopenia (white cell count 2·6 × 109 L−1) and thrombocytopenia (platelet count 36 × 109 L−1). Hepatitis B surface antigen, antihepatitis C antibody and serum level of α‐fetoprotein (AFP) were within normal limits. Two years prior to the development of cutaneous lesions, a 1·5‐cm, irregularly demarcated, low‐density intrahepatic mass with marginal enhancement was detected by computed tomography (CT) at the S6 segment of the liver, and percutaneous ultrasonically guided needle biopsies of the liver mass had been performed twice.