Abstract
IntroductionHepatoid adenocarcinoma is a special type of extrahepatic alpha-fetoprotein-producing adenocarcinoma, which has a morphologic similarity to hepatocellular carcinoma. We report a patient with underlying hepatitis B virus infection and hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma.Case presentationWe present the case of a 56-year-old Chinese female with underlying hepatitis B virus infection, who was found to have multiple hepatic tumors by abdominal ultrasound and an elevated level of serum alpha-fetoprotein. Hepatocellular carcinoma was considered based on the image findings, the elevated level of serum alpha-fetoprotein. and underlying hepatitis B virus infection. Moreover, the subsequent endoscopy revealed gastric tumor. However, the tumor histology of the stomach and liver revealed glandular adenocarcinoma with hepatoid foci. The final diagnosis is hepatoid adenocarcinoma of the stomach with liver metastasis.ConclusionHepatoid adenocarcinoma is an aggressive tumor with liver metastasis being the first clinical manifestation of the neoplasm. Hepatoid adenocarcinoma of the stomach with liver metastasis should be considered in older patients with elevated serum alpha-fetoprotein and multiple hepatic tumors with underlying chronic liver disease. An upper gastrointestinal endoscopy should be performed to exclude the possibility of hepatoid adenocarcinoma originating from the stomach to avoid potential misdiagnosis and inappropriate therapy.
Highlights
Hepatoid adenocarcinoma is a special type of extrahepatic alpha-fetoproteinproducing adenocarcinoma, which has a morphologic similarity to hepatocellular carcinoma
We report a patient with underlying hepatitis B virus infection and hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma
Case presentation: We present the case of a 56-year-old Chinese female with underlying hepatitis B virus infection, who was found to have multiple hepatic tumors by abdominal ultrasound and an elevated level of serum alpha-fetoprotein
Summary
Hepatoid adenocarcinoma (HAC) is a special type of extrahepatic adenocarcinoma, which has a morphologic similarity to hepatocellular carcinoma (HCC) [1]. The abdominal pain became progressively worse and most tender in the right upper quarter (RUQ) She had had HBV infection for 15 years but follow up was irregular. Abdominal computed tomography (CT) showed multiple hepatic tumors sized 3-7 cm in the bilateral lobes of the liver and wall thickening in the stomach (Figure 1A). Based on the image findings, the elevated AFP and underlying HBV infection of the patient, HCC was highly suspected and a US-guided liver biopsy was performed for definite diagnosis (Figure 2A). The results of IHC study revealed reactivity to Hepatocyte paraffin 1 (Hep Par 1), AFP, and polyclonal and monoclonal CEA in the tumors of both liver and stomach (Figure 2C and 2D).
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