1
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Iwasaki S, Hidaka H, Uojima H, Kubo H, Adachi K, Wada N, Kubota K, Nakazawa T, Shibuya A, Kusano C. A case of successful treatment with lenvatinib in primary hepatoid adenocarcinoma of the gallbladder that was difficult to distinguish from hepatocellular carcinoma. Clin J Gastroenterol 2022; 15:1108-1114. [DOI: 10.1007/s12328-022-01686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022]
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2
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Okura K, Esaki M, Nara S, Ban D, Takamoto T, Shimada K, Hiraoka N. Hepatoid carcinoma and related entities of the extrahepatic bile duct: A clinicopathological study of four cases. Pathol Int 2022; 72:332-342. [PMID: 35472251 DOI: 10.1111/pin.13226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/02/2022] [Indexed: 01/01/2023]
Abstract
Hepatoid carcinoma or related entities (HPC/RTs) are extremely rare, especially in the extrahepatic bile duct (EHBD). Only a few case reports have been published. We analyzed the clinicopathological features of HPCs/RTs in EHBD. HPC/RT of extrahepatic cholangiocarcinoma (eCCA) cases were selected based on the histological characteristics and immunohistochemical detection of spalt-like transcription factor 4 (SALL4) and/or alpha-fetoprotein (AFP). Four HPC/RT cases arose in the distal but not in the perihilar EHBD. The four patients with HPC/RT included one female and three males with a median age of 77 years. There are various macroscopic types of HPC/RT. The predominant histological features were two solid-type carcinomas that mimicked hepatocellular carcinoma and two well-differentiated tubular adenocarcinomas. Immunohistochemically, SALL4 and glypican-3 were expressed in all cases, and AFP was expressed in one case. Cancer cell phenotypes included intestinal, pancreatobiliary, and mixed pancreatobiliary and intestinal types. Focal neuroendocrine differentiation and severe perineural and lymphovascular invasions were also observed. HPC/RT recurred in two patients within 2 years, and one patient died 13 months postoperatively. It is suggested that the HPC/RT of EHBD shares common characteristics with HPC/RT arising in various organs, and has some unique characteristics. HPC/RT of EHBD might be more aggressive than conventional eCCA.
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Affiliation(s)
- Keisuke Okura
- Department of Analytical Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Minoru Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Ban
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Takamoto
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuaki Shimada
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuyoshi Hiraoka
- Department of Analytical Pathology, National Cancer Center Research Institute, Tokyo, Japan
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3
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Qian X, Zhou D, Gao B, Wang W. An alpha-fetoprotein-negative hepatoid adenocarcinoma of the gallbladder with squamous differentiation. Hepatobiliary Surg Nutr 2020; 9:116-118. [PMID: 32140496 DOI: 10.21037/hbsn.2019.12.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Xiaohui Qian
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Dongkai Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Bingqiang Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Weilin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, China
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4
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Akturk G, Sagol O, Unek T, Ozbilgin M, Egeli T, Karademir S, Obuz F, Astarcioglu IK. Alpha-Fetoprotein-Secreting Gallbladder Carcinoma: a Case Report. J Gastrointest Cancer 2019; 49:528-531. [PMID: 28462448 DOI: 10.1007/s12029-017-9950-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Guray Akturk
- Department of Pathology, Cigli Education and Research Hospital, Izmir, Turkey.
| | - Ozgul Sagol
- Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tarkan Unek
- Department of General Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Mucahit Ozbilgin
- Department of General Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tufan Egeli
- Department of General Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sedat Karademir
- Department of General Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Funda Obuz
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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5
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Yoshioka S, Ishida M, Okano K, Sandoh K, Ebisu Y, Miyasaka C, Yamamoto T, Ryota H, Satoi S, Tsuta K. Cytological features of hepatoid adenocarcinoma of the gallbladder: A case report with immunocytochemical analyzes. Diagn Cytopathol 2018; 46:711-715. [PMID: 29637715 DOI: 10.1002/dc.23935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/15/2022]
Abstract
Hepatoid adenocarcinoma is defined as an extrahepatic malignant neoplasm showing morphological and immunohistochemical resemblance of hepatocellular carcinoma. The occurrence of this type of tumor in the gallbladder is extremely rare. In this study, we report the first cytological case of hepatoid adenocarcinoma of the gallbladder. An 80-year-old Japanese female was found to have a tumorous lesion in the gallbladder. Papanicolaou smear of the ascites demonstrated a few epithelial cell clusters composed of round to oval neoplastic cells with distinct cell border and large centrally-located nuclei. Tumor touch smear of the resected tumor revealed the presence of two distinct neoplastic components. The first component was composed of clusters or sheets of epithelial cells with distinct cell border, relatively rich clear cytoplasm, and centrally-located nuclei, as seen in the ascites specimen. The other component was composed of tall columnar cells with large basally-oriented nuclei, and glandular formation was noted as well. Immunocytochemical analyzes of the touch smear material demonstrated that the former component was positive for HepPar1, thus it was considered as a hepatoid adenocarcinoma, and the latter component deemed as a typical adenocarcinoma. Histopathological and immunohistochemical examination of the resected gallbladder tumor confirmed a diagnosis of hepatoid adenocarcinoma. The characteristic cytological features of hepatoid adenocarcinoma are the presence of sheets or clusters of neoplastic cells with distinct cell border and centrally-located nuclei. Immunocytochemical analysis for HepPar1 may help its diagnosis. Demonstration of hepatoid adenocarcinoma is important in the cytological specimen because this type of tumor shows an aggressive clinical course.
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Affiliation(s)
- Saya Yoshioka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Kimiaki Okano
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Kaori Sandoh
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Yusuke Ebisu
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | | | - Hironori Ryota
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
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6
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Koyama K, Maeda D, Tamura D, Narita C, Kudo-Asabe Y, Sato T, Yamamoto Y, Sageshima M, Nanjo H, Goto A. Fetal gut-like differentiation in gallbladder cancer. Hum Pathol 2017; 70:27-34. [PMID: 28970139 DOI: 10.1016/j.humpath.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022]
Abstract
Adenocarcinomas showing fetal gut-like (enteroblastic) differentiation can arise in a variety of organs and are frequently accompanied by an elevated serum α-fetoprotein (AFP) level. However, no study has investigated fetal gut-like differentiation in gallbladder cancer in detail. Herein, we performed morphological and immunohistochemical analyses of fetal gut-like differentiation in 49 consecutive gallbladder cancer cases. The expression of Sal-like protein 4 (SALL4), an embryonic stem cell marker reported to represent fetal gut-like differentiation, as well as other oncofetal proteins, including glypican-3 (GPC3) and AFP, was assessed. We found 1 case of fetal gut-like adenocarcinoma that coexisted with conventional-type adenocarcinoma. The fetal gut-like adenocarcinoma component revealed diffuse immunoreactivity for SALL4 and partial positivity for AFP, whereas the conventional-type adenocarcinoma component was negative. We also found 2 poorly differentiated adenocarcinomas with hepatoid morphology and 1 clear cell carcinoma, none of which showed SALL4 positivity. In other conventional-type adenocarcinomas, focal immunoreactivity for SALL4 and GPC3 was occasionally observed. The overall positivity rates for SALL4 and GPC3 were 12.2% (6/49) and 16.3% (8/49), respectively. SALL4 and GPC3 expression was not associated with clinicopathological factors, including T category, lymphovascular invasion, and lymph node metastases. In conclusion, fetal gut-like adenocarcinoma was found in 2% of our gallbladder cancer series. We conclude that fetal gut-like adenocarcinoma is a distinct histological subtype of gallbladder cancer, characterized by SALL4 expression.
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Affiliation(s)
- Kei Koyama
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan; Faculty of Medicine, Akita University, Akita, 010-8543, Japan
| | - Daichi Maeda
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan.
| | - Daisuke Tamura
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan; Department of Obstetrics and Gynecology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan
| | - Chisato Narita
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan; Faculty of Medicine, Akita University, Akita, 010-8543, Japan
| | - Yukitsugu Kudo-Asabe
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan
| | - Tsutomu Sato
- Department of Surgery, Akita City Hospital, Akita, 010-0933, Japan
| | - Yuzo Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan
| | - Masato Sageshima
- Department of Pathology, Akita City Hospital, Akita, 010-0933, Japan
| | - Hiroshi Nanjo
- Department of Pathology, Akita University Hospital, Akita, Akita 010-8543, Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan
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7
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Karayiannakis AJ, Kakolyris S, Giatromanolaki A, Courcoutsakis N, Bolanaki H, Chelis L, Sivridis E, Simopoulos C. Hepatoid Adenocarcinoma of the Gallbladder : Case Report and Literature Review. J Gastrointest Cancer 2016; 43 Suppl 1:S139-44. [PMID: 21935757 DOI: 10.1007/s12029-011-9326-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Anastasios J Karayiannakis
- Second Department of Surgery, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece.
| | - Stylianos Kakolyris
- Department of Clinical Oncology, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece
| | - Nikos Courcoutsakis
- Department of Radiology and Medical Imaging, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece
| | - Helen Bolanaki
- Second Department of Surgery, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece
| | - Leonidas Chelis
- Department of Clinical Oncology, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece
| | - Efthimios Sivridis
- Department of Pathology, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece
| | - Constantinos Simopoulos
- Second Department of Surgery, Democritus University of Thrace, Medical School, 68 100, Alexandroupolis, Greece
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8
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Devi NRS, Sathyalakshmi R, Devi J, Lilly SM. Hepatoid Adenocarcinoma of the Gall Bladder-A Rare Variant. J Clin Diagn Res 2015; 9:ED09-10. [PMID: 26435955 DOI: 10.7860/jcdr/2015/10799.6324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 05/26/2015] [Indexed: 11/24/2022]
Abstract
Hepatoid adenocarcinoma is a rare variant of extra hepatic adenocarcinoma, consisting of foci of both adenomatous and hepatocellular differentiation with morphological and functional resemblance to hepatocellular carcinoma and hence correct diagnosis is a challenge. The most frequent site is stomach. We present this case of hepatoid carcinoma of the gallbladder for its rarity and difficulty in diagnosis which on histology showed papillae, sheets and trabaculae of polygonal cells with eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli with adjacent foci showing high grade dysplasia.
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Affiliation(s)
- Nalli R Sumitra Devi
- Professor, Department of Pathology, Stanley Medical College , Tamil Nadu Dr. MGR Medical University, India
| | - R Sathyalakshmi
- Assistant Professor, Department of Pathology, Stanley Medical College , Tamil Nadu Dr. MGR Medical University, India
| | - J Devi
- Postgraduate, Department of Pathology, Stanley Medical College , Tamil Nadu Dr. MGR Medical University, India
| | - S Mary Lilly
- HOD & Professor, Department of Pathology, Stanley Medical College , Tamil Nadu Dr. MGR Medical University, India
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9
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Ellouze S, Slim C, Ahmad G, Naourez G, Ali A, Héla M, Mariem K, Mohamed BA, Tahia B. Hepatoid adenocarcinoma of the gallbladder. World J Surg Oncol 2011; 9:103. [PMID: 21914163 PMCID: PMC3180410 DOI: 10.1186/1477-7819-9-103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 09/13/2011] [Indexed: 11/20/2022] Open
Abstract
Hepatoid adenocarcinoma is a rare variant of extrahepatic adenocarcinoma which behaves like hepatocellular carcinoma in morphology and functionality. We present a rare case of hepatoid adenocarcinoma of the gallbladder which invades deeply the liver bed, in a 59-year-old woman. Histologically, most of the mass in the gallbladder was composed of cells with eosinophilic cytoplasm arranged in a trabecular pattern, which resembled hepatocellular carcinoma. The main differential diagnosis was hepatocellular carcinoma with invasion into the gallbladder. The gallbladder origin of the hepatoid adenocarcinoma was verified by the presence of foci of conventional adenocarcinoma, the recognition of high-grade dysplasia in the adjacent epithelium and the absence of cirrhosis.
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Affiliation(s)
- Sameh Ellouze
- Department of Pathology, Habib Bourguiba Hospital, road El Ain., 3029, Sfax, Tunisia.
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10
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Lee JH, Lee KG, Paik SS, Park HK, Lee KS. Hepatoid adenocarcinoma of the gallbladder with production of alpha-fetoprotein. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80:440-4. [PMID: 22066073 PMCID: PMC3204683 DOI: 10.4174/jkss.2011.80.6.440] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 03/08/2010] [Indexed: 11/30/2022]
Abstract
Hepatoid adenocarcinoma (HAC) is a tumor with aberrant hepatocellular differentiation that occurs in extrahepatic organs. HAC of the gallbladder is rare, and cases of alpha-fetoprotein production are extremely rare. A 61-year-old man was diagnosed with gallbladder adenocarcinoma after laparoscopic cholecystectomy. A radical operation including resection of liver bed and lymph node dissection was performed, and no tumor cell was found. However, at postoperative 19 months, he showed lymphadenopathy of the portocaval area and tumor thrombi in the right portal vein with high levels of serum alpha-fetoprotein. After right hemihepatectomy and portahepatis lymph node dissection was performed, he was diagnosed with metastatic HAC. On reviewing the gallbladder specimen, the tumor finally demonstrated HAC as the primary origin. Despite adjuvant therapy, the patient died from multiple liver metastasis 26 months after cholecystectomy. Although HAC of the gallbladder is a very rare malignancy, awareness of its existence is critical to avoid misdiagnosis.
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Affiliation(s)
- Jae Hoon Lee
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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11
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Kanzaki R, Yamada T, Gotoh K, Takahashi H, Murata M, Tomita Y, Yano M, Ohigashi H, Sasaki Y, Ishikawa O. Surgical resection for hepatocellular carcinoma with metastasis to the gallbladder: report of a case. Surg Today 2011; 41:285-91. [PMID: 21264771 DOI: 10.1007/s00595-010-4223-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 01/12/2010] [Indexed: 12/27/2022]
Abstract
A metastatic tumor of the gallbladder is rare. There have so far been no detailed reports of a resection of the metastasis of hepatocellular carcinoma (HCC) to the gallbladder published in the English literature. This report presents the case of a surgical resection for hepatocellular carcinoma with metastasis to the gallbladder. A 48-year-old woman consulted her primary care physician due to chest discomfort. Tumors in the liver and gallbladder were unexpectedly found and she was thus referred to this hospital. The radiologic studies showed two tumors. A round-shaped tumor, 30 mm in diameter, in the fossa of the gallbladder of the liver protruded into the lumen of the gallbladder, and a lobulated shaped tumor, measuring 13 mm, was in S5 of the liver. Angiography demonstrated that these tumors showed a pattern of early enhancement and washout. An en bloc resection of the gallbladder and the liver surrounding the gallbladder was performed, and the final diagnosis was moderately differentiated HCC in segment S5 with gallbladder metastasis. The patient is currently doing well 2 years after surgery, without any signs of recurrence. This case demonstrated that good clinical outcome could be achieved by performing surgery in HCC patients with metastasis to the gallbladder.
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Affiliation(s)
- Ryu Kanzaki
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, Japan
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12
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Hepatoid adenocarcinoma: computed tomographic imaging findings with histopathologic correlation in 6 cases. J Comput Assist Tomogr 2008; 31:846-52. [PMID: 18043368 DOI: 10.1097/rct.0b013e318038f6dd] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hepatoid adenocarcinoma (HAC) is a special type of primary tumor with aberrant hepatocellular differentiation occurring in extrahepatic organs. Our objective was to review the computed tomographic findings of HAC and to correlate the imaging features with histopathologic findings. Institutional review board approval was obtained for this study. METHODS The computed tomographic findings images in 6 consecutive patients with pathologically proven HAC were reviewed retrospectively. Five patients were men and 1 was a woman (mean age, 56 years; age range, 36-68 years). All patients underwent contrast-enhanced computed tomography (CT) performed on a 4-slice multidetector row CT scanner. The mean time interval between CT and surgery was 5 days. Two radiologists who were unaware of the final histological diagnosis reviewed all computed tomographic images retrospectively. Lesion characteristic (ie, number, location, size, density, enhancement, heterogeneity, margin, distribution, presence of necrosis, lymphadenopathy, and distant metastasis) were evaluated. The correlation between the imaging and the pathological findings was analyzed. RESULTS Most patients had elevated serum alpha-fetoprotein levels (n = 4). The HAC appeared as large tumors (mean size, 4.2 x 3.4 x 3.9 cm), isodense at unenhanced CT (n = 4), moderately enhanced (n= 5), with necrotic areas (n = 6), regional lymphadenopathy (n = 5), and distant metastases (n = 4). The heterogeneity on computed tomographic images correlated well with the presence of hemorrhage and necrosis. CONCLUSIONS In an old patient with a large necrotic and moderately vascular tumor, the presence of distant metastases, regional lymphadenopathy, and characteristic increased serum alpha-fetoprotein level may suggest a diagnosis of HAC.
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13
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van den Bos IC, Hussain SM, Dwarkasing RS, Stoop H, Zondervan PE, Krestin GP, de Man RA. Hepatoid adenocarcinoma of the gallbladder: a mimicker of hepatocellular carcinoma. Br J Radiol 2008; 80:e317-20. [PMID: 18065642 DOI: 10.1259/bjr/97773297] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
We present a case of a large gallbladder tumour in a patient with no known liver disease and elevated alpha-fetoprotein (AFP), in whom a differential diagnosis from hepatocellular carcinoma (HCC) in a non-cirrhotic liver was particularly difficult given the combination of the size of the tumour, solitary nature, elevated AFP and striking resemblance with HCC at histology. In presenting this patient, we would like to emphasise the role of MRI as a problem-solving tool for analysis of rare tumours of non-hepatocellular origin, including hepatoid adenocarcinoma of the gallbladder.
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Affiliation(s)
- I C van den Bos
- Department of Radiology, University Medical Center Rotterdam, The Netherlands.
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14
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Lee MW, Lee JY, Kim YJ, Park EA, Choi JY, Kim SH, Lee JM, Han JK, Choi BI. Gastric hepatoid adenocarcinoma: CT findings. ACTA ACUST UNITED AC 2007; 32:293-8. [PMID: 16967243 DOI: 10.1007/s00261-006-9073-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In this study, we evaluated the CT findings of patients with hepatoid adenocarcinoma of the stomach. METHODS The CT scans of eight patients (seven males and one female; age range 44-70 years; mean age 59 years) with histologically proven hepatoid adenocarcinoma of the stomach were retrospectively evaluated by two radiologists in consensus. Scans were evaluated for gastric wall thickening, involved site enhancement, adjacent organ invasion, lymphadenopathy, distant metastases, and venous tumor thrombosis. RESULTS Tumors appeared as eccentric wall thickening (n = 8) and heterogeneous enhancement (n = 7). Adjacent organ invasions were noted to liver (n = 3), pancreas (n = 2), and esophagus (n = 1). All eight patients had a regional lymphadenopathy larger than 8 mm in its short axis. Distant metastases (liver, n = 4; non-regional lymph node, n = 1) were also noted. Venous tumor thrombosis was identified in the portal vein (n = 3), splenic vein (n = 1), main portal vein (n = 1), or right gastroepiploic vein (n = 1) in the regions near primary gastric tumors or metastatic masses. CONCLUSION On CT scans, hepatoid adenocarcinoma of the stomach appears as an eccentric gastric wall thickening and shows a strong tendency for liver and lymph node metastasis and venous invasion around the primary gastric tumor or a metastatic hepatic mass.
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Affiliation(s)
- Min Woo Lee
- Department of Radiology, Konkuk University Hospital, Seoul, South Korea
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