Pulmonary hepatoid adenocarcinoma: report of a case.

Yamato Motooka,Yumi Honda,Makoto Suzuki,Koei Ikeda,Kentaro Yoshimoto,Takeshi Mori,Ken-Ichi Iyama,Takashi Semba

doi:10.1186/s40792-016-0129-6

Yamato Motooka, Yumi Honda + Show 6 more

Open Access

https://doi.org/10.1186/s40792-016-0129-6

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Abstract

Hepatoid adenocarcinoma (HAC) is a rare neoplasm with aberrant hepatocellular differentiation. HAC occurs in extrahepatic organs such as the gastrointestinal tract, testes, ovaries, and lungs and frequently produces alpha-fetoprotein. A 69-year-old patient was diagnosed clinically with T2aN0M0, stage IB, non-small cell lung carcinoma. Because the tumor showed tight adhesion to the chest wall, we performed left upper lobectomy, combined resection of the 3rd and 4th ribs, and lymph node dissection. Pathological examination confirmed the diagnosis of HAC of the lung (pathological T2aN0M0, stage IB), and four courses of cisplatin and gemcitabine were administered as adjuvant chemotherapy. Genetic analysis of the epidermal growth factor receptor showed wild type. Preoperative serum alpha-fetoprotein level, a useful marker of disease progression, was elevated to 4497 ng/ml, decreasing within the normal range by about 3 months postoperatively. The patient remains alive without recurrence as of 51 months after surgery.

Highlights

Hepatoid adenocarcinoma (HAC) is a rare neoplasm showing aberrant hepatocellular differentiation
We describe a case of pulmonary HAC treated by complete resection and adjuvant chemotherapy
HAC is associated with large tumor, AFP production, poor prognosis, a predilection for older patients, regional lymphadenopathies, and distant metastases [2, 6]

Summary

Background

Hepatoid adenocarcinoma (HAC) is a rare neoplasm showing aberrant hepatocellular differentiation. HAC occurs in extrahepatic organs such as the gastrointestinal tract, testes, ovaries, and lungs and frequently produces AFP. HAC in any extrahepatic organs is reportedly associated with poor prognosis. We describe a case of pulmonary HAC treated by complete resection and adjuvant chemotherapy. Case presentation In March 2011, chest X-ray detected abnormal shadows in the left lung of a 69-year-old man with a 40-pack-year history of smoking. The resected specimens showed hepatocellular features such as a pseudo-biliary tract pattern (Fig. 1c). Immunohistochemical staining showed tumor cells with focal positivity for AFP (Fig. 1d), carcinoembryonic antigen (Fig. 1e), glypican 3 (Fig. 1f ), hepatocytespecific antigen (Fig. 1g), protein induced by vitamin K absence or antagonist (Fig. 1h), and CD56.

Discussion

Conclusions