α-Fetoprotein-Producing Hepatoid Gastric Adenocarcinoma With Osteoclast-Like Giant Cells and Neuroendocrine Differentiation

Wincewicz, Andrzej; Kowalik, Artur; Zięba, Sebastian; Lewitowicz, Piotr; Góźdż, Stanisław; Sulkowski, Stanisław

doi:10.1177/1066896915586807

Cited by 10 publications

(6 citation statements)

References 18 publications

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“…The patient is this case had mutations in multiple genes, including driver gene mutation like EGFR and genes involved in DNA repair such as TP53 and MLH1 . This finding is consistent with a previous report by Wincewicz et al, [ 18 ] in which mutations in a patient with hepatoid gastric carcinoma included TP53 , EGFR , ATM , and CDKN2A .…”

Section: Discussionsupporting

confidence: 93%

Non-α-fetoprotein-producing adrenal hepatoid adenocarcinoma

Lin

Cao²,

Yu³

et al. 2018

Medicine

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Rationale:Adrenal hepatoid adenocarcinoma typically secretes alpha-fetoprotein (AFP). Here, we report a case of non-AFP-producing adrenal hepatoid adenocarcinoma. Next-generation sequencing (NGS) was conducted to identify gene mutations.Patient concerns:A 64-year-old man presented with mild back pain and unexplained weight loss for 3 months.Diagnoses:Contrast-enhanced magnetic resonance imaging (MRI) showed a mass (9.9 × 9.7 × 9.1 mm3) above the upper pole of the left kidney. The left renal artery and vein were compressed. The tumor was positive for CK8/18, CK19, CK7, hepatocyte marker (Hepatocyte), and Hep Par 1, but negative for AFP. Plasma AFP was 2.75 ng/mL (normal range: 0–7 ng/mL). NGS revealed mutations of the following genes: ATM, CDKN2A, EGFR, STK11, TP53, BIM, and MLH1. A diagnosis of adrenal hepatoid adenocarcinoma was established.Interventions:The treatment included 4 cycles of the mFOLFOX6 regimen (oxaliplatin, leucovorin, and fluorouracil), transcatheter arterial chemoembolization, and apatinib.Outcomes:The patient died 9 months after the diagnosis.Lessons:This case highlights the importance of thorough clinical, radiological, and immunohistochemical investigation for suspected adrenal hepatoid adenocarcinoma. Metastasis from other primary tumors should be ruled out. Furthermore, AFP is not necessarily elevated in adrenal hepatoid adenocarcinoma. NGS could be helpful in establishing the diagnosis and selecting treatments.

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Section: Discussionsupporting

confidence: 93%

Non-α-fetoprotein-producing adrenal hepatoid adenocarcinoma

Lin

Cao²,

Yu³

et al. 2018

Medicine

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“…The so-called composite or mixed tumour with hepatoid and neuroendocrine differentiation in the same gastric tumour has been reported,[ 42–44 ] which has also been encountered in HAC tumours of other locations (i.e. pancreas).…”

Section: Discussionmentioning

confidence: 95%

Hepatoid adenocarcinoma of the stomach – proper identification and treatment remain a challenge

Søreide

Greve

Gudlaugsson

et al. 2016

Scandinavian Journal of Gastroenterology

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Objective The term hepatoid adenocarcinoma (HAC) of the stomach was introduced three decades ago with the observation of high serum α-fetoprotein (AFP) levels in some gastric adenocarcinoma patients. This very rare gastric cancer patient subgroup is likely frequently misdiagnosed. Material Two patients who were recently diagnosed with HAC of the stomach at our institution are presented. We also performed a structured literature search and reviewed pertinent articles to provide knowledge to improve the proper identification, diagnosis and management of patients with gastric HAC. Results HAC is a rare subgroup of gastric carcinoma with poor prognosis. Clinical management of this population may be challenging. The scientific literature is largely based on very small patient series or case reports, and the evidence for proper decision making and management is considered weak. Conclusion All physicians involved in the diagnosis and treatment of patients with gastric cancer should pay attention to this rare subgroup to improve identification.

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“…It was thought that GHAC might arise from some cancers through hepatic differentiation; the adenocarcinomatous and hepatoid areas were often intermingled with each other, and an extensive venous involvement by tumor cells was noted. 18 , 19 The cells of GHAC grow, proliferate, and invade surrounding tissues with significant accompanying venous infiltration and elevated serum AFP levels. 3 , 19 …”

Section: Discussionmentioning

confidence: 99%

Effect of immune checkpoint inhibitors in patients with gastric hepatoid adenocarcinoma: a case report and literature review

et al. 2022

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Gastric hepatoid adenocarcinoma (GHAC) is a highly aggressive histological subtype of gastric cancer (GC) with similar tissue morphology to hepatocellular carcinoma. GHAC frequently produces alpha-fetoprotein (AFP) and has a poor prognosis; however, standardized treatment remains elusive. We report a male patient in his early 60s with GHAC who received immunotherapy, and the curative effect was evaluated. He was admitted because of progressive fatigue and dizziness for 2 months. He had experienced spontaneous epigastric pain with muscular defense of the epigastrium and accompanying tenderness 1 year earlier and underwent radical gastrectomy. Immunohistochemistry showed that hepatocyte-specific marker (Hep) was highly-expressed, indicating probable GHAC. Additionally, imaging suggested GC recurrence or gastric stump cancer. Radioimmunoassay indicated an AFP level of >1210.00 µg/L, and liver biopsy was performed following abdominal contrast-enhanced computed tomography. Pathology showed a few hepatocytes and proliferative fibrous connective tissue. The patient received three cycles of chemotherapy, with no obvious improvement. The possibility of surgical treatment was excluded, and immunotherapy or palliative treatment was selected. He received 11 cycles of a programed death-1 (PD-1) monoclonal antibody, and the effect of treatment was satisfactory. The mechanism of action of immunotherapy in GHAC warrants further investigation.

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α-Fetoprotein-Producing Hepatoid Gastric Adenocarcinoma With Osteoclast-Like Giant Cells and Neuroendocrine Differentiation

Cited by 10 publications

References 18 publications

Non-α-fetoprotein-producing adrenal hepatoid adenocarcinoma

Non-α-fetoprotein-producing adrenal hepatoid adenocarcinoma

Hepatoid adenocarcinoma of the stomach – proper identification and treatment remain a challenge

Effect of immune checkpoint inhibitors in patients with gastric hepatoid adenocarcinoma: a case report and literature review

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