We studied clinicopathological and immunohistochemical features of hepatocellular carcinoma (HCC) with sarcomatous change among surgically resected HCC cases. Among 308 HCC cases, 6 (1.9%) showed partial (5 cases) or entire (1 case) sarcomatous change. Only 1 case received preoperative anti-cancer therapy among the 6 cases, suggesting that sarcomatous change is not always related to anti-cancer therapy. Immunohistochemically, the sarcomatous components were positive for albumin and alpha 1-antichymotrypsin and negative for alpha-fetoprotein in all cases. Expressions of intermediate filament-related proteins (e.g., cytokeratin and vimentin) in the sarcomatous components were heterogeneous. The sarcomatous components showed stronger expressions of p53 protein and/or mouse double minute-2 protein, and higher proliferating cell nuclear antigen labeling index, suggesting their high proliferative activity and high malignant potential.

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