{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:49:41Z","timestamp":1782276581611,"version":"3.54.5"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Primary hepatic carcinosarcoma is an exceptionally rare and highly aggressive malignancy, and ectopic \u03b2-hCG production and paraneoplastic leukemoid reaction are both uncommon findings in solid tumors. We report the case of a 47-year-old woman who initially presented with abnormal vaginal bleeding and elevated serum \u03b2-hCG, raising concern for a pregnancy-related disorder. Diagnostic curettage showed no evidence of pregnancy or trophoblastic disease, yet the \u03b2-hCG level continued to rise. At the same time, she developed extreme leukocytosis, and bone marrow examination favored a leukemoid reaction rather than hematologic malignancy. Imaging subsequently revealed a rapidly enlarging mass in the right hepatic lobe with necrosis, satellite lesions, vascular involvement, and hilar nodal disease. Surgical resection was performed because the lesion was considered resectable and tissue diagnosis was required. Histopathology demonstrated a poorly differentiated primary hepatic carcinosarcoma with \u03b2-hCG expression in a subset of tumor cells. After surgery, the white blood cell count, serum \u03b2-hCG, and PIVKA-II levels all fell markedly, supporting their paraneoplastic origin. However, the tumor recurred rapidly, and the patient died approximately 1 month after surgery. This case shows that persistent \u03b2-hCG elevation and marked leukocytosis, when unexplained by gynecologic or hematologic disease, may rarely be the presenting clues to an aggressive primary hepatic malignancy. Importantly, persistent \u03b2-hCG elevation and marked leukocytosis should not be interpreted in isolation as gynecologic or hematologic disease when imaging reveals a rapidly enlarging liver mass.<\/jats:p>","DOI":"10.3389\/fonc.2026.1864613","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:44:37Z","timestamp":1782276277000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Primary hepatic carcinosarcoma with ectopic \u03b2-hCG secretion and a paraneoplastic leukemoid reaction mimicking gynecologic and hematologic disease"],"prefix":"10.3389","volume":"16","author":[{"given":"Pin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary Oncology, Zhongshan Hospital, Fudan University","place":["Shanghai, China"]},{"name":"Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Oncology, Zhongshan Hospital, Fudan University","place":["Shanghai, China"]},{"name":"Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Oncology, Zhongshan Hospital, Fudan University","place":["Shanghai, China"]},{"name":"Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000213431.07116.e0","article-title":"Primary carcinosarcoma of the liver: clinicopathologic features of 5 cases and a review of the literature","volume":"31","author":"Lao","year":"2007","journal-title":"Am J Surg Pathol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-012-1946-y","article-title":"Clinicopathological characteristics and outcome of primary sarcomatoid carcinoma and carcinosarcoma of the liver","volume":"16","author":"Wang","year":"2012","journal-title":"J Gastrointest Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/s1665-2681(19)31015-4","article-title":"Hepatic carcinosarcoma: clinicopathologic features and a review of the literature","volume":"12","author":"Lin","year":"2013","journal-title":"Ann Hepatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s40644-018-0141-0","article-title":"Primary carcinosarcoma of the liver: imaging features and clinical findings in six cases and a review of the literature","volume":"18","author":"Li","year":"2018","journal-title":"Cancer Imaging"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2147\/jhc.s272768","article-title":"The clinicopathological and imaging characteristics of primary hepatic carcinosarcoma and a review of the literature","volume":"7","author":"Bin","year":"2020","journal-title":"J Hepatocell Carcinoma"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/bf00708253","article-title":"Human chorionic gonadotropin in primary liver carcinoma in adults. An immunohistochemical study","volume":"409","author":"Nakanuma","year":"1986","journal-title":"Virchows Arch A Pathol Anat Histopathol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1827.2006.01979.x","article-title":"Carcinosarcoma of the liver producing granulocyte-colony stimulating factor","volume":"56","author":"Aita","year":"2006","journal-title":"Pathol Int"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3350\/kjhep.2011.17.3.226","article-title":"A case of leukemoid reaction in a patient with sarcomatous hepatocellular carcinoma","volume":"17","author":"Shin","year":"2011","journal-title":"Korean J Hepatol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v7.i11.1330","article-title":"Paraneoplastic leukemoid reaction in a patient with sarcomatoid hepatocellular carcinoma: A case report","volume":"7","author":"Hu","year":"2019","journal-title":"World J Clin cases"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/coc.0b013e3182a530dd","article-title":"Paraneoplastic leukemoid reaction in solid tumors","volume":"38","author":"Chakraborty","year":"2015","journal-title":"Am J Clin Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2020.153295","article-title":"Paraneoplastic leukemoid reaction: Case report and review of the literature","volume":"217","author":"Abukhiran","year":"2021","journal-title":"Pathol Res Pract"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1864613\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:45:03Z","timestamp":1782276303000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1864613\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":11,"alternative-id":["10.3389\/fonc.2026.1864613"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1864613","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"1864613"}}