Hepatoid adenocarcinoma of the gallbladder: Case report and review of the literature

Abstract

A rare case of hepatoid adenocarcinoma (HAC) of the gallbladder occurred in a 72-year-old man who presented with abdominal pain and was admitted to hospital. Ultrasonography and computed tomography revealed a mass in the gallbladder, multiple nodules in the liver and enlargement of the lymph nodes. He was diagnosed as having a gallbladder carcinoma with multiple liver and lymph node metastases. Cholecystectomy and partial hepatectomy was performed. Histologically, most of the mass in the gallbladder was composed of cells with eosinophilic cyto-plasm arranged in a trabecular pattern, which resembled hepatocellular carcinoma, but there was a component of well-differentiated adenocarcinoma in the mucosa. Immunohistochemically these hepatoid tumor cells were positive for Hepatocyte (Hepatocyte Paraffin 1: Hep Par1), which is considered highly sensitive and highly specific for hepatocyte differentiation. Based on these findings, this case was diagnosed as hepatoid adenocarcinoma of the gallbladder, which is generally a vary rare neoplasm in the literature, but should be included in the differential diagnosis of a mass in the gallbladder.

Hepatoid Adenocarcinoma – Review of the Literature Illustrated by a Rare Case Originating in the Peritoneal Cavity

“…Oftheothertumourmarkers,especiallyCEAisoftenproducedbyHAC.PositivityforCEAwasobservedin50-100% of all published cases, occurring in all HAC of the pancreas [27,28],ovaries,andfallopiantube [21,[29][30][31][32][33][34][35][36],in86%ofthe gallbladdercases [10,22,23,37,38],andin51%ofthegastric HAC [7,8,10,11,24]. Our patient had normal CEA serum concentrations,butthetumourcellswereweaklystainedby CEAinconcordancewiththeotherpublishedHACcaseof theperitonealcavity [15].Noticeablefordiagnosticreasonsis thepositivityforCEA,AFP,andCA125orthedetectionof elevatedserumlevelsofCA125inovarianHAC [21,29,[31][32][33][34][35][36].TheCEAstainingis,however,oflittlevaluefordifferentiationbetweenHACandHCC,asthemajorityofHCCare alsoCEA-positive [39].…”

“…It has, however, to be emphasisedthatelevatedAFPlevelsandAFPpositivityarenot alwayspresentinHAC.MostofthecasesareAFP-positive, revealinganAFPconcentrationofuptoseveralthousandng/ ml;however,valuesslightlyabovethenormalrangeandAFPnegative cases were also reported. The latter accounted for about 7% and originated from the stomach (n = 5) [2,6], ovary(n=1) [21],gallbladder(n=3) [22,23],pancreas(n= 1) [24],oesophagus(n=1) [25],andthymus(n=1) [26] (table 2). In the current case, there was also no increased AFP presentintheserumorascitesfluid.Thetumourcellsstained AFP-negativeashasbeendescribedin12%ofthepublished cases.Thesefindingswerehelpfultodefinitelyexcludeagerm celltumourwhichwastheonlypossiblealternativetoHACnotonlyduetothemorphologicalappearance,butalsoonaccountoftheyoungageofourpatient.…”

Surgical resection for hepatocellular carcinoma with metastasis to the gallbladder: Report of a case

“…7-10 The differential diagnosis between HAC in the gallbladder and HCC was made by immunohistochemistry. 8 Adenocarcinoma of the bile duct is im munoreactive for CK19, whereas HCC is not. 7,11 The cells of the gallbladder tumor in the current case were positive for immunohistochemical staining using hepatocyte-specifi c antigen and negative for CK19, thus suggesting that this tumor had the characteristics of HCC and not those of HAC of the gallbladder.…”

Grading der Tumoren des hepatobiliären Systems

“…Per definitionem besteht es zu mehr als 50 % aus hepatoiden Zellen, die sich trabekulär anordnen. Daneben sollten auch Abschnitte eines klassischen Adenokarzinoms enthalten sein [10,15] …”