Liver Metastasis of Hepatoid Colonic Adenocarcinoma: A Rare and Unusual Entity With Poor Prognosis and Review of the Literature

Abstract

Hepatoid adenocarcinoma (HAC) is rare and was first reported as α-fetoprotein (AFP)-producing tumor. It is an important variant of extrahepatic adenocarcinoma with clinicopathological presentation mimicking hepatocellular carcinoma and carries exceedingly poor prognosis. HAC most commonly originates in the stomach, and less commonly in the ovary, esophagus, lung, among other organs. HAC originating in the colon is exceedingly rare. Here we report such a case of a 63-year-old man presented as decompensated liver failure with jaundice and weakness. Computed tomography (CT) imaging findings showed multiple lesions in the liver with ascites and descending colonic mass suspicious for malignancy. The flexible sigmoidoscopy showed a 1.5 cm mass in the descending colon, and biopsy showed superficial fragments of tubular adenoma, but could not exclude deep invasive carcinoma. A liver biopsy was performed and showed a carcinoma with morphologic features resembling hepatocellular carcinoma. The tumor cells were positive for glypican-3, MOC31, CDX2, SATB2 and CK20, negative for arginase-1, p63, synaptophysin and chromogranin. Ki-67 highlighted 80% of the tumor cells. The pathology diagnosis was liver with metastatic hepatoid adenocarcinoma consistent with colonic primary. The patient experienced a rapid worsening of his liver function and died 3 weeks later of hepatic failure without any surgery and chemotherapy. A subsequent literature review of the 17 reported cases of HAC showed that this type of cancer frequently metastasizes to the liver with an astonishingly poor prognosis with eight patients died of the disease in less than 5 months after the diagnosis was made. Radical surgery followed by adjuvant chemotherapy with chemotherapy regimen used for colorectal cancer or primary hepatocellular carcinoma may be the treatment option for colorectal HAC.

Molecular and clinicopathological features of colorectal adenocarcinoma with enteroblastic differentiation

“…23 In contrast, Hu et al reported a case of GLP3-positive colonic adenocarcinoma with a poor prognosis. 24 In the present study, GLP3-positive CRCs had a poor prognosis. In addition, we found that AFP was the rarest marker (eight of 971 cases, 0.82%) among three enteroblastic markers.…”

Higher expression of SATB2 in hepatocellular carcinoma of African Americans determines more aggressive phenotypes than those of Caucasian Americans

“…The liver is the first and most common organ to which cancers commonly metastasize and spread in patients. Recent studies have demonstrated the higher expression of SATB2 in the HCC tissues compared with adjacent normal tissues . The commonly used markers for the HCC include metastatic carcinomas markers cytokeratins (CK7, CK19 and CK20), neuroendocrine markers (CD56, synaptophysin and chromogranin A) and tissue‐specific markers (SATB2, CDX2, TTF‐1, GCDFP‐15, mammaglobin, etc) .…”

“…Recent studies have demonstrated the higher expression of SATB2 in the HCC tissues compared with adjacent normal tissues. 25,26,53,54 The commonly used markers for the HCC include metastatic carcinomas markers cytokeratins (CK7, CK19 and CK20), neuroendocrine markers (CD56, synaptophysin and chromogranin A) and tissue-specific markers (SATB2, CDX2, TTF-1, GCDFP-15, mammaglobin, etc). 54 microRNAs (miRNAs) regulate cancer cell progression and metastasis by modulating the expression of SATB2.…”

Colorectal adenocarcinoma with enteroblastic differentiation: a clinicopathological study of five cases

“…Hu et al reported a case of metastatic colorectal adenocarcinoma with hepatoid features of the liver which was positive for GPC3. 29 Therefore, GPC3 may not only be useful to diagnose CAED, but could also be suggestive of metastatic colorectal adenocarcinoma.…”