Hepatoid adenocarcinoma of the lung

Abstract

Lung adenocarcinomas with a mixture of tubular or papillary pattern, sheet-like or trabecular architecture, eosinophilic cytoplasm with centrally located nuclei and alpha-fetoprotein-producing cells have been described as hepatoid adenocarcinomas. Hepatoid adenocarcinomas are mainly found in the stomach but rare cases in other organs have been described. Immunostaining for alpha-fetoprotein (AFP), hepatocyte paraffin 1 (HepPar-1) and thyroid transcription factor-1 (TTF-1) helps in the diagnostic workup. Tumor behavior is still not entirely known but it seems to be associated with early metastases. We report on a 66-year-old, heavy-smoker male patient who had a 10-month history of respiratory complaints and weight loss. At the time he was hospitalized, respiratory failure was already established. The computed tomography corresponded to a collapsed right lung due to a poorly defined expanding mass. The bronchoscopy revealed narrowing of the inferior and medium lobar bronchi. The patient developed irreversible shock and died. At the right lung inferior lobe was extensively replaced by a grayish diffuse neoplasia in a "pneumonia-like" gross pattern. Metastatic disease was found in the right adrenal gland and thoracic and abdominal lymph nodes. Microscopic dissemination through lymphatics, pleura, and airways was detected. Histological examination revealed a poorly differentiated adenocarcinoma with hepatoid features. Immunohistochemmistry stains were positive for keratin 7, polyclonal carcinoembryonic antigen (CEA) in a diffuse pattern, AFP and HepPar-1 antibody. TTF-1 showed a diffuse granular cytoplasmic staining of the neoplastic cells, and only focal nuclear positivity. Multiple bilateral emboli originated from deep venous thrombosis were present in large and medium branches of the pulmonary artery and contributed to the cause of death.

Hepatoid Adenocarcinoma of the Stomach: Current Perspectives and New Developments

“…Most tumors have metastasized at diagnosis with a poor prognosis due to their aggressive behavior (1,2). Hepatoid adenocarcinoma(HAC) has been reported to occur in the stomach (3), esophagus (4,5), duodenum (6), jejunum (2), colon (7), peritoneum (8), pancreas (9)(10)(11)(12)(13), lung (14), ovary (15,16), gallbladder (17), uterus (16,18) and other sites (19). Of these locations, the stomach is the most common site of HAC.…”

MRI features of hepatic metastasis from hepatoid adenocarcinoma of the stomach: A case report

“…later named it as hepatoid adenocarcinoma of the stomach (HAS) [2] . HAC can occur in the stomach, intestine, pancreas, ovary, lung and other sites, among which the stomach is the most common site [3] , [4] , [5] , [6] , [7] . HAS accounts for 0.17%-15% of all gastric cancers.…”

Primary Hepatoid Adenocarcinoma of the Lung: A Study of Two Cases with Review of Literature

“…We found that only 34 cases of primary HAC lung have been reported in the world literature before December 2018. [3][4][5][6][7][8][9][10][11][12][13] Grossman et al reviewed 28 cases of HAC lung reported in the English literature, between January 1980 and June 2015. [5] Additional six case reports have been published from June 2015 to December 2018 including one Indian case report by Vellaisamy et al [3] In these reported 34 cases of primary HAC lung, 33 were males with age ranging from 36 to 77 years (mean 57 years).…”