Objective:

To report a case of primary hepatic carcinosarcoma presenting with elevated β-hCG and leukocytosis, emphasizing the diagnostic challenges encountered.

Approach:

• Patient Presentation: A 47-year-old woman presented with abnormal vaginal bleeding and elevated serum β-hCG, initially suspected to be pregnancy-related.
• Diagnostic Workup: Diagnostic curettage showed no evidence of pregnancy. Continued β-hCG elevation and extreme leukocytosis led to further imaging.
• Imaging and Diagnosis: Imaging revealed a rapidly enlarging hepatic mass. Surgical resection was performed, confirming poorly differentiated primary hepatic carcinosarcoma.
• Postoperative Findings: Post-surgery, β-hCG, white blood cell count, and PIVKA-II levels fell significantly, indicating a paraneoplastic relationship.

Key Findings:

• Persistent β-hCG elevation and extreme leukocytosis can indicate an aggressive primary hepatic malignancy.
• Histopathology confirmed poorly differentiated primary hepatic carcinosarcoma with β-hCG expression.
• The patient experienced rapid tumor recurrence and died approximately one month post-surgery.

Interpretation:

Elevated β-hCG and leukocytosis should not be solely attributed to gynecologic or hematologic disorders when a hepatic mass is present.

Limitations:

• The case is based on a single patient, limiting generalizability to broader populations.
• Diagnostic challenges may delay recognition of underlying malignancies.

Conclusion:

This case illustrates the importance of considering solid tumors in the differential diagnosis of elevated β-hCG and leukocytosis when a hepatic mass is present.