Background: Primary liver cancer is the second most common cancer in Asia, hepatocellular carcinoma being the most common histological type. Hepatocellular carcinoma with sarcomatoid features and osteoclast like giant cells is a rare malignancy and has higher risk of metastasis as compared to usual Hepatocellular carcinoma. Case Description: We recently encountered an autopsy case of cirrhotic liver with sarcomatoid variant of Hepatocellular carcinoma in a 59 year old male. Macroscopically, it presented as a grey white to grey yellow ill defined nodule with central necrosis and surrounding micronodular cirrhotic changes. Microscopically, tumor predominantly composed of two cell types were noticed- classical hepatocellular carcinoma with atypical hepatocytes and pleomorphic spindle cells with frequent mitosis and multinucleated giant cells. As the tumor had both epithelial and mesenchymal differentiation in the same lesion, the diagnosis of sarcomatoid variant of hepatocellular carcinoma was made. Literature Review: Sarcomatoid variant of carcinoma has to have both epithelial and mesenchymal differentiation in the same lesion. Occasionally when the tumor is fully composed of malignant spindle cells, it is difficult to distinguish from various primary sarcomas and has to be confirmed by immunohistochemical staining Clinical relevance: The prognosis of the sarcomatoid variant of Hepatocellular carcinoma is unfavourable compared with classical Hepatocellular carcinoma which could be attributed to aggressive intrahepatic spreading and frequent metastasis. Histopathological study is the only effective diagnostic tool for confirmation.

Keywords: Hepatocellular Carcinoma; Sarcomatoid; Osteoclast Like Giant Cells.