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      Liver metastasis from hepatoid adenocarcinoma of the esophagus mimicking hepatocellular carcinoma

      case-report

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          Abstract

          Alpha-fetoprotein (AFP)-producing adenocarcinoma, histologically mimicking hepatocellular carcinoma (HCC), is a distinct entity known as hepatoid adenocarcinoma (HAC). Reported cases of HAC arising from the esophagus are extremely rare. Due to common liver metastasis and elevated AFP levels in patients with esophageal HAC, differentiation of HAC with liver metastasis from HCC could be challenging. We describe a case of esophageal HAC that presented with a liver mass showing hepatoid features and elevated serum AFP levels. Initial presentation was suspicious for HCC. Upon further diagnostic work-up, the patient was diagnosed with esophageal HAC with liver metastasis. The distinction between these two entities is particularly important because HAC is more aggressive, and its therapeutic options are very limited.

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          An AFP-producing gastric carcinoma with features of hepatic differentiation. A case report.

          Y Akishima-Fukasawa, M. Aizawa, H Ishikura … (1985)
          A patient with primary gastric adenocarcinoma with extremely high serum alpha-fetoprotein (AFP) levels (12,000 ng/ml) is described. Histologically, foci strongly resembling hepatocellular carcinoma with hyaline globules were noted. Within tumor cells, AFP was identified with both light and electron microscopy, showing the production of AFP by tumor cells themselves. Furthermore, 88% of serum AFP combined with Concanavalin A (ConA), revealing that it was hepatic-type AFP and not germ-cell-type. Localization of alpha-1-antitrypsin within tumor cells was also noted. Ultrastructural study showed that there were two types of structures corresponding to periodic acid-Schiff (PAS)-positive globules, one of which, the proteinaceous material in intracytoplasmic lumina, was found to contain AFP. Among gastric adenocarcinomas with a high serum AFP level (several thousand or more ng/ml of AFP), foci resembling hepatocellular carcinomas have been reported by several investigators. Those gastric carcinomas, together with the current case, may constitute a clinicopathologic entity, hepatoid adenocarcinoma of the stomach.
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            Clinicopathological characteristics in the differential diagnosis of hepatoid adenocarcinoma: a literature review.

            Jiann-Sheng Su, Yu-Tso Chen, Ren-Ching Wang … (2013)
            Hepatoid adenocarcinoma (HAC) is a rare but important special type of extrahepatic adenocarcinoma with clinicopathological presentation mimicking hepatocellular carcinoma (HCC), and prompt and correct diagnosis can be a challenge, especially in endemic areas with a high incidence of HCC. To date, HAC has only been reported in case series or single case reports, so we aimed to review the clinicopathological characteristics of HAC to obtain a more complete picture of this rare form of extrahepatic adenocarcinoma. All the articles about HAC published from 2001 to 2011 were reviewed, and clinicopathological findings were extracted for analysis. A late middle-aged male with high serum α-fetoprotein and atypical image finding of HCC should raise the suspicion of HAC, and characteristic pathological immunohistochemical stains can help with the differential diagnosis. Novel immunohistochemical markers may be useful to clearly differentiate HAC from HCC. Once metastatic HAC is diagnosed, the primary tumor origin should be identified for adequate treatment. The majority of HAC originates from the stomach, so panendoscopy should be arranged first.
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              Comparative immunohistochemical profile of hepatocellular carcinoma, cholangiocarcinoma, and metastatic adenocarcinoma.

              Karly Geller, Gregory S K Lau, Randa Alsabeh … (2002)
              Distinguishing hepatocellular carcinoma (HCC) from cholangiocarcinoma (CC) and metastatic adenocarcinoma (MA) involving the liver can be problematic, often requiring the use of immunohistochemistry to facilitate diagnosis. Hep Par 1, a monoclonal antibody with expression confined primarily to benign and malignant hepatocytes, has recently become commercially available. We evaluated Hep Par 1 along with other immunohistochemical markers used to differentiate HCC, CC, and MA, including AE1/AE3, CAM 5.2, B72.3, monoclonal carcinoembryonic antigen (mCEA), polyclonal CEA (pCEA), alpha-fetoprotein (AFP), factor XIIIa, inhibin, CD10, villin, MOC-31, cytokeratin (CK) 7, CK 19, and CK 20, to determine the markers most useful in differentiating these entities. Forty-two cases of HCC, 9 cases of CC, and 56 cases of MA (24 colon, 15 pancreas, 8 ovary, 5 breast, and 4 stomach) were studied. Hep Par 1 was sensitive and specific for HCC, with 38 of 42 (90%) cases staining positively, whereas reactivity was observed in only 8 of 56 (14%) MAs and 0 of 9 CCs. Though limited somewhat by poor sensitivity, a bile canalicular pattern of staining with pCEA, CD10, and villin was specific for HCC and was not observed in the other tumors. Lack of mCEA and MOC-31 immunoreactivity was also characteristic of HCCs. CK 19 positivity favored CC over HCC, but was not useful in differentiating CC from MA. Expression of AFP, although observed in only about one third of the cases, favored HCC over CC and MA. CK 7 and CK 20 were also useful in this differential diagnosis, particularly when dealing with MA of colonic origin. AE1/AE3, CAM 5.2, B72.3, inhibin, and factor XIIIa were noncontributory in differentiating these entities. Copyright 2002, Elsevier Science (USA). All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Gastroenterol Rep (Oxf)
                Journal ID (iso-abbrev): Gastroenterol Rep (Oxf)
                Journal ID (publisher-id): gastro
                Title: Gastroenterology Report
                Publisher: Oxford University Press
                ISSN (Electronic): 2052-0034
                Publication date (Print): February 2017
                Publication date (Electronic): 20 June 2015
                Publication date PMC-release: 20 June 2015
                Volume: 5
                Issue: 1
                Pages: 67-71
                Affiliations
                [1 ]Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
                [2 ]Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
                Author notes
                [* ] Corresponding author. Division of Gastroenterology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, South Tower, Suite 7511, Los Angeles, CA 90048, USA. Tel: +1-310-423-3690; Fax: +1-310-423-6554; Email: Laith.Jamil@ 123456cshs.org
                Article
                Publisher ID: gov021
                DOI: 10.1093/gastro/gov021
                PMC ID: 5444241
                PubMed ID: 26094198
                SO-VID: 1e15d1f4-dfe8-47c1-9a48-67c8bb12317e
                Copyright © © The Author(s) 2015. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 February 2015
                Date revision received : 10 April 2015
                Date accepted : 26 April 2015
                Page count
                Pages: 5
                Categories
                Subject: Case Reports

                Keywords: hepatoid adenocarcinoma,alpha-fetoproteins,hepatocellular carcinoma
                Data availability:
                Keywords: hepatoid adenocarcinoma, alpha-fetoproteins, hepatocellular carcinoma

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