Hepatoid adenocarcinoma of the colon

Abstract

Hepatoid adenocarcinoma (HAC) is a rare extrahepatic adenocarcinoma that morphologically and immunophenotypically mimics hepatocellular carcinoma (HCC). We report the case of a 42-year-old woman with an extensive cancer history who presented with right-sided abdominal pain and lower gastrointestinal (GI) bleeding, and was ultimately diagnosed with colon adenocarcinoma. She underwent sigmoidectomy and adjuvant chemotherapy. Approximately 1 month after completion of chemotherapy, positron emission tomography showed presence of a 1.8 cm×1.4 cm mesenteric lymph node. She underwent treatment with chemotherapy and radiation followed by lymph node resection. Pathological findings from the lymph node were consistent with poorly differentiated carcinoma with hepatocellular differentiation. When compared with pathology from the colonic resection, both specimens showed histomorphological features and immunohistochemical profiles consistent with hepatocellular differentiation. Given these findings, a diagnosis of HAC of the colon with metastasis to a mesenteric lymph node was made.

Clinicopathological features and prognosis of intestinal hepatoid adenocarcinoma: evaluation of a pooled case series

“…Moreover, the imaging appearance of IHA is not specific. They usually present as large masses with the same density of the normal liver on baseline imaging and are moderately enhanced after administration of an intravenous iodinated medium, which show no differences with other malignant tumors [ 30 , 32 ]. Additionally, even preoperative biopsy can rarely obtain a definitive diagnosis of IHA.…”

Hepatoid Adenocarcinoma of the Duodenum: An Unusual Location

“…The median age at occurrence is 63 ± 12.8 years (range 21–100) [ 3 ]. The most common site of origin of HAC is the stomach, comprising about 84% of all HAC cases [ 5 ]. However, HAC accounts for only 0.19% of gastric cancers, a testament to its rarity [ 6 ].…”

“…Elevated serum AFP is, however, only seen in 84.8% of HAC cases, and thus, although considered characteristic of HAC, it is not a universal marker [ 1 , 3 ]. Major immunohistochemical markers in cases of HAC include AFP, CEA, glypican-3, CK18, and CK19 [ 5 ]. Hep Par 1 staining is usually negative in HAC, but it may occasionally show focus-positive staining [ 6 ].…”

“…HAC is an aggressive tumor and has a poor prognosis, with median overall survival estimated at 11 months [ 1 ]. Patients frequently present with metastases, with lymph nodes and the liver being the most common sites of metastasis [ 5 ]. With regard to treatment, there is no standardized approach, since due to the rarity of HAC no randomized clinical trials are possible.…”

“…With regard to treatment, there is no standardized approach, since due to the rarity of HAC no randomized clinical trials are possible. According to the published case reports and series, the favored approach is to treat gastrointestinal HAC similarly to colorectal adenocarcinoma: with surgical resection if possible, followed by adjuvant chemotherapy with FOLFOX (5-fluorouracil, leucovorin, and oxa-liplatin) or FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) regimens, with or without bevacizumab [ 1 , 3 , 5 ]. The prognosis remains poor despite chemotherapy, especially in cases with nodal involvement.…”