Hepatoid Adenocarcinoma With Liver Metastasis Mimicking Hepatocellular Carcinoma

Abstract

Hepatoid adenocarcinoma (HAC) is a special type of extrahepatic adenocarcinoma, which has a striking morphologic similarity to hepatocellular carcinoma. Seven HACs arising in the stomach and one in the lung, all with liver metastasis, were studied. They shared clinical features, such as old age, high serum alpha-fetoprotein level, aggressive behavior, and hepatic tumor in absence of risk factors for hepatocellular carcinoma (HCC). Morphologically, tumors were characterized by an admixture of tubulo-and/or papillary adenocarcinoma with hepatoid foci. In six cases, liver metastases showed an exclusive hepatoid differentiation, virtually indistinguishable from HCC with solid growth pattern. As HAC and HCC cannot be differentiated on the basis of morphology alone, differences in immunohistochemical reaction patterns would be of considerable diagnostic help. Immunostaining for CK7, CK8, CK18, CK19, CK20, alpha-fetoprotein, p-CEA, and HepPar1 revealed that hepatoid areas of both primary and metastatic HAC have a specific immunoprofile, distinctive of this entity. On the one hand, positivity of virtually all HACs for alpha-fetoprotein, CK8, CK18, and the membranous, canalicular staining for polyclonal carcinoembryonic antigen underline its hepatoid nature. On the other hand, positive staining for CK19 and CK20 and frequent negativity for HepPar1 in both primary tumors and their metastases were distinctive features of HAC. Furthermore, HAC differs from combined hepatocellular cholangiocarcinoma, being negative for CK7. In addition, for comparison of immunohistochemical results, we stained with the same antibody panel a tissue microarray of 121 HCCs. Comparative genomic hybridization study of three HAC supports their hepatoid differentiation as aberrations found in HAC are common in HCC (4q-, 8p-), and hepatoblastoma (Xq+), respectively.

Incidence of gastric cancer, its subtypes, and correlation with Helicobacter Pylori

“…Since itsfirst description in the stomach, which is the most common location, it has been described in different organs such as lung, pancreas, esophagus, papilla of Vater, colon, urinary bladder, renal pelvis, ovaries, uterus, and cervix. 19 In this study among all 49 cases of adenocarcinoma one case was of hepatoid adenocarcinoma. HAC consisted of polygonal tumor cells with large central nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm ( fig.…”

An isolate alpha-fetoprotein producing gastric cancer liver metastasis emerged in a patient previously affected by radiation induced liver disease

“…Other than AFP production, gastric cancer and hepatocarcinoma (HCC) can share common histology features, as demonstrated in the case of the hepatoid adenocarcinoma (HAC) of the stomach. As described by Terracciano et al [6] , HAC is an extrahepatic tumor with morphological features similar to HCC, often producing large amounts of AFP. The findings from Terracciano et al [6] suggest that HAC arises from gastric adenocarcinoma with an intestinal phenotype as a result of the further progression of the carcinogen process.…”

“…As described by Terracciano et al [6] , HAC is an extrahepatic tumor with morphological features similar to HCC, often producing large amounts of AFP. The findings from Terracciano et al [6] suggest that HAC arises from gastric adenocarcinoma with an intestinal phenotype as a result of the further progression of the carcinogen process. The stomach is the organ where the tumor was most fre-…”

“…Terracciano et al [6] showed positivity in virtually all HACs for AFP, cytokeratin-8 (CK-8), CK-18 and carcinoembryonic antigen, markers underlining its hepatoid nature, the contemporary positive staining for CK-19 and CK-20, and the frequent negativity of Hep Par1 in both primary tumors and their metastases. Furthermore, HAC differs from combined hepatocellular cholangiocarcinoma, because it is negative for CK-7 [6] . Because HAC liver metastases and HCC cannot be differentiated on the basis of morphology alone, the described pattern of phenotypical markers is necessary for differential diagnosis.…”

Case Series of Gastric Hepatoid Adenocarcinoma

“…1 이와 같은 여러 기관 중 위가 가장 흔한 발병 부위이나, 간세포양 위샘암종(gastric hepatoid adenocarcinoma)은 위암 (gastric adenocarcinoma)의 0.3∼1%를 차지하는 드문 형태 의 종양이다. 2 간세포양 샘암종은 다량의 알파태아단백(alpha fetoprotein, AFP)을 분비하여, 혈중 상승된 AFP를 보인다.…”