Pancreatic Hepatoid Carcinoma Mimicking a Solid Pseudopapillary Neoplasm: A Challenging Case on Endoscopic Ultrasound-guided Fine-needle Aspiration

Akimoto, Yutaka; Kato, Hironari; Matsumoto, Kazuyuki; Harada, Ryo; Oda, Shinsuke; Fushimi, Soichiro; Mizukawa, Shou; Yabe, Shuntaro; Uchida, Daisuke; Seki, Hiroyuki; Tomoda, Takeshi; Yamamoto, Naoki; Horiguchi, Shigeru; Tsutsumi, Keisuke; Yagi, T.; Okada, Hiroyuki

doi:10.2169/internalmedicine.55.6741

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…The diagnosis of pure pancreatic HC based solely on preoperative imaging studies is difficult due to the non-specific radiologic features of this tumor [21]. In fact, none of the patients who underwent preoperative imaging studies such as CT received a precise diagnosis because of the radiographic characteristics with various vascular patterns in tumor enhancement.…”

Section: Discussionmentioning

confidence: 99%

Pure pancreatic hepatoid carcinoma: a surgical case report and literature review

et al. 2019

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BackgroundHepatoid carcinoma (HC) is an extra-hepatic neoplasm that shares the morphological and immunohistochemical features of hepatocellular carcinoma. Pancreatic HC exists as either pure or combined type. Pure pancreatic HC is extremely rare, with only a few cases reported in the literature to date. Because of the rarity of pure pancreatic HC, its clinical features including incidence, behavior, and prognosis remain unclear. We herein report the case of a 56-year-old man who developed pure pancreatic HC treated with surgical resection. We also include a review of the existing literature.Case presentationA 56-year-old male patient was admitted to our hospital after a pancreatic cyst was identified by abdominal ultrasonography on a comprehensive medical examination. Endoscopic ultrasound revealed a cystic mass measuring 13 mm in size in the pancreatic head and a low-density mass measuring 16 mm in size in the pancreatic tail, which was partially enhanced on contrast-enhanced ultrasound. Contrast-enhanced computed tomography (CT) revealed a branch duct type intraductal papillary mucinous neoplasm in the pancreatic head and an early enhanced nodule measuring approximately 10 mm in size in the pancreatic tail. Endoscopic ultrasound-guided fine-needle aspiration of the hypervascular tumor was performed. The hypervascular tumor was suspected to be a solid pseudopapillary neoplasm. Laparoscopic spleen-preserving distal pancreatectomy was performed. Histology was identical to hepatocellular carcinoma of the liver. Immunohistochemically, the tumor cells were positive for hepatocyte paraffin 1, and a canalicular pattern was confirmed on the polyclonal carcinoembryonic antigen staining. The patient was diagnosed with a moderately differentiated pancreatic HC. The patient was followed up without adjuvant chemotherapy, and there was no evidence of recurrence at 6 months post-operatively.ConclusionsWe present a case of moderately differentiated pure pancreatic HC. For the accurate preoperative diagnosis of pure pancreatic HC, biopsy is preferred to cytology or preoperative imaging studies such as CT. The prognosis of pure pancreatic HC depends on its differentiation.

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Section: Discussionmentioning

confidence: 99%

Pure pancreatic hepatoid carcinoma: a surgical case report and literature review

et al. 2019

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“…Hepatoid carcinomas of the pancreas are often positive for hepatocellular immunohistochemical markers (Table 4) such as AFP (18/27 or 67%), Hep Par1 (25/26 or 96%), glypican-3 (7/9 or 78%), and arginase-1 (3/4 or 75%). 9-38 Hepatoid carcinomas with pure HCC-like morphology are less likely to be immunohistochemically positive for AFP (9/17 or 53%) than those with other differentiation (9/9 or 100%; P = .007). Among the hepatoid carcinomas with neuroendocrine differentiation, those with homogeneous tumor cells show AFP 22,38 and Hep Par1 22,34 in the same group of cells, whereas those with 2 different populations of cells show positive AFP and Hep Par1 in the hepatoid component but not in the neuroendocrine component.…”

Section: Discussionmentioning

confidence: 99%

“…50 So far, none of the reported PHCs, including our 3 cases, occurred in children. 9-38 Pancreatic neuroendocrine tumors (islet cell tumors) may contain oncocytic cytoplasm 51 and should be distinguished from hepatoid carcinoma with neuroendocrine differentiation. Pancreatic neuroendocrine tumors are negative for glypican-3.…”

Section: Discussionmentioning

confidence: 99%

“…3-8 The first primary pancreatic hepatoid carcinoma (PHC) was reported by Hruban et al in 1987. 9 So far, only 31 primary PHCs have been reported in the English literature, 9-38 and the vast majority of them are single case reports except 1 study with 2 cases. 12 In addition, the vast majority of these reports were in nonpathology journals, * and therefore, the pathological features of these tumors and their correlation with prognosis have not been analyzed.…”

Section: Introductionmentioning

confidence: 99%

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Primary Hepatoid Carcinoma of the Pancreas: A Clinicopathological Study of 3 Cases With Review of Additional 31 Cases in the Literature

et al. 2018

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Primary pancreatic hepatoid carcinoma (PHC) is very rare. Here, we reported 3 such cases with review of additional 31 cases in the literature. Our 3 patients were male (83, 72, and 54 years old, respectively). Serum α-fetoprotein (AFP) was elevated in 1 patient (case 3, 8338 ng/mL) and not measured in the other two. The PHC in patient 1 (pathological stage pT2N0M0) and patient 2 (pT3N0M0) showed pure hepatocellular carcinoma (HCC)-like morphology, whereas in case 3 it was a PHC with true glandular differentiation (pT4N0M0). The diagnosis of PHC was confirmed with positive immunohistochemical staining in the tumor cells for AFP (2/3), Hep Par 1 (3/3), glypican-3 (2/3), arginase-1 (2/3), and Sal-like protein 4 (1/3). CD10 and polyclonal carcinoembryonic antigen stains show focal canalicular pattern in 2/3 tumors. Patient 1 did not receive further treatment after resection and was alive with no evidence of disease at 107 months. Patient 2 died of postoperative complications, whereas patient 3 received postsurgical chemoradiation and died of disease at 29 months. Our findings and literature review indicate that PHCs can be divided into 4 histological subtypes: with pure HCC-like morphology (n = 22), with neuroendocrine differentiation (n = 8), with true glandular differentiation (n = 3), and with acinar cell differentiation (n = 1). On univariate analysis, pure HCC-like morphology was associated with better disease-specific survival (DSS; P = .04), whereas lymph node and distant metastases were associated with worse DSS ( P = .002 for both). Age, gender, presenting symptoms, serum AFP level, and T stage were not associated with DSS. On multivariate analysis, none of these parameters was significantly associated with DSS.

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“…Imaging examination is crucial for the preoperative diagnosis of SPTP. It can determine the size and location of the tumor and its relationship with surrounding tissues, thus providing detailed information to make a surgical protocol[2,7,8]. The typical ultrasonographic finding of SPTP is a cystic/solid mass with mixed density in the pancreas.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic panniculitis and solid pseudopapillary tumor of the pancreas: A case report

Zhang

Tian

2018

WJCC

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Solid pseudopapillary tumor of the pancreas (SPTP), also known as solid and papillary epithelial neoplasm of the pancreas, is a rare pancreatic exocrine tumor that is difficult to diagnose before surgery. Pancreatic panniculitis is a rare type that occurs in less than 3% of all patients with pancreatic diseases. We here report a 19-year-old woman who presented with persistent left upper quadrant pain without obvious cause for 1 d. The patient also developed subcutaneous nodules involving lower abdomen bilaterally and lower limbs, and subcutaneous nodules were pathologically diagnosed as pancreatic panniculitis. Plain abdominal computed tomography revealed a soft-tissue mass in the body and tail of the pancreas, which was closely associated with the gastric wall. Contrast-enhanced ultrasound showed inhomogeneous echogenicity in the anterior pancreatic body, which had blurred parenchymal demarcation of the body and tail of the pancreas. Contrast-enhanced abdominal computed tomography revealed a mixed density mass with solid and cystic components in the body and tail of the pancreas, and the solid component was markedly enhanced. The lesion was pathologically diagnosed as SPTP after laparoscopic resection. Clinicians should be aware of the clinical manifestation, diagnosis, and treatment of pancreatic panniculitis and SPTP.

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Pancreatic Hepatoid Carcinoma Mimicking a Solid Pseudopapillary Neoplasm: A Challenging Case on Endoscopic Ultrasound-guided Fine-needle Aspiration

Cited by 9 publications

References 33 publications

Pure pancreatic hepatoid carcinoma: a surgical case report and literature review

Pure pancreatic hepatoid carcinoma: a surgical case report and literature review

Primary Hepatoid Carcinoma of the Pancreas: A Clinicopathological Study of 3 Cases With Review of Additional 31 Cases in the Literature

Pancreatic panniculitis and solid pseudopapillary tumor of the pancreas: A case report

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