1
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Li L, Yang X, Ji W, Zhu Q, Yang X, Niu J, Li W. Emphasis on the clinical relationship between alpha-fetoprotein and hepatoid adenocarcinoma of the stomach: a retrospective study. BMC Gastroenterol 2023; 23:142. [PMID: 37161409 PMCID: PMC10170827 DOI: 10.1186/s12876-023-02773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/19/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Hepatoid adenocarcinoma of the stomach (HAS) is a highly malignant and rare extrahepatic tumor. The prognosis is controversial because of its rarity and the lack of multi-center cohort studies, especially on the influence of serum Alpha-fetoprotein (AFP) level on prognosis. We aimed to analyze the clinicopathological characteristics and prognosis of HAS, particularly the effect of serum AFP on the prognosis of HAS. METHODS We retrospectively reviewed clinical data of one HAS patient treated at our institution in 2019 and of 252 patients reported between 1984 and 2020 in research databases. RESULTS Among these patients, 60.1% were > 60 years, 51% had lesions in the gastric antrum, and 51.0% (73/143) had the ulcerative lesion type. The preoperative elevated levels of serum alpha-fetoprotein (AFP) were detected in most patients (76.7%). Lymph-node (84.6%) and preoperative liver metastasis (39.1%) were often found. The high-AFP group was characterized by a higher rate of stage IV (P = 0.000682) and liver metastasis (P = 0.000068). The 1-, 3-and 5-year progression-free survival(PFS) rates were 41%, 18%, and 0%, and the 1-, 3-, and 5-year overall survival (OS) rates were 64%, 26%, and 21%, respectively. The survival analysis showed that OS was significantly shorter for HAS with high-AFP (> 300 ng/ml) than with low-AFP (≤ 300 ng/ml) (P = 0.023). The univariate analysis indicated that the OS of HAS was associated with tumor location, pTNM stage, lymph-node metastasis, surgical resection, and serum AFP > 300 ng/ml. However,the prognostic factors for PFS was only pTNM stage and surgical resection. The multivariate analysis confirmed that the independent prognostic factor affecting OS of HAS included pTNM stage and surgical resection. CONCLUSIONS Liver metastasis was increasingly more likely with increasingly higher serum AFP, but the prognosis of HAS is not necessarily poor. Serum AFP level is an important prognostic indicator in HAS and should be monitored.
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Affiliation(s)
- Lamei Li
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, N0.157 Xiwu Road,New Urban District, Xi'an, Shanxi Province, 710004, China
| | - Xinle Yang
- Department of Hepatology, First Hospital, Jilin University, N0.71 Xinmin Street,Chaoyang District, Changchun, 130021, Jilin Provinice, China
| | - Wei Ji
- Department of Oncology, First Hospital, Jilin University, N0.71 Xinmin Street,Chaoyang District, Changchun, 130021, Jilin Provinice, China
| | - Qi Zhu
- Department of Hepatology, First Hospital, Jilin University, N0.71 Xinmin Street,Chaoyang District, Changchun, 130021, Jilin Provinice, China
| | - Xin Yang
- Department of Hepatology, First Hospital, Jilin University, N0.71 Xinmin Street,Chaoyang District, Changchun, 130021, Jilin Provinice, China
| | - Junqi Niu
- Department of Hepatology, First Hospital, Jilin University, N0.71 Xinmin Street,Chaoyang District, Changchun, 130021, Jilin Provinice, China
| | - Wanyu Li
- Department of Hepatology, First Hospital, Jilin University, N0.71 Xinmin Street,Chaoyang District, Changchun, 130021, Jilin Provinice, China.
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2
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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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3
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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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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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Zhang C, Zhang W, Mu D, Shi X, Zhao L. A clear cell adenocarcinoma of the gallbladder with hepatoid differentiation: case report and review of literature. Onco Targets Ther 2016; 9:5797-5802. [PMID: 27703378 PMCID: PMC5036547 DOI: 10.2147/ott.s103291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
An 80-year-old male was referred to our department for a gallbladder mass. He denied any history of alcohol consumption or cholecystitis and smoking. Hepatitis B surface antigen test and antihepatitis C antibody test were found to be negative. Serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen were elevated (CA19-9 was 59.92 U/mL and carcinoembryonic antigen was 12.64 ng/mL), whereas alpha-fetoprotein was below the normal limit (2.46 ng/mL). Computed tomography scan revealed a solid mass with measurements of 4.6×5.6×7.1 cm, which nearly filled the whole gallbladder space. Radical cholecystectomy, including segments IV B and V of the liver and lymphadenectomy, was performed. The neoplasm in gallbladder was completely resected, and the patient obtained a negative margin. Histological and immunohistochemical profile suggested a clear cell adenocarcinoma of the gallbladder with hepatoid differentiation. After reviewing the literature, we reported that this case is the first identified case of cell adenocarcinoma of the gallbladder with extensive hepatoid differentiation. However, clinical features of clear cell adenocarcinoma with hepatoid differentiation remain unclear due to the extremely rare incidence. There was no indication of adjuvant chemotherapy and no literature has been reported on the application of chemotherapy. This case showed a promising clinical outcome after curative resection, which indicated that surgical treatment could be potentially considered for suitable patients.
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Affiliation(s)
- Chengsheng Zhang
- Department of Hepatobiliary Surgery, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
| | - Wei Zhang
- Department of Hepatobiliary Surgery, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
| | - Dianbin Mu
- Department of Hepatobiliary Surgery, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science
| | - Xuetao Shi
- Department of Hepatobiliary Surgery, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science
| | - Lei Zhao
- Department of Hepatobiliary Surgery, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
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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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Veerankutty FH, Yeldho V, Tu SA, Venugopal B, Manoj KS, Vidhya C. Hepatoid carcinoma of the pancreas combined with serous cystadenoma: a case report and review of the literature. Hepatobiliary Surg Nutr 2015; 4:354-62. [PMID: 26605284 DOI: 10.3978/j.issn.2304-3881.2015.05.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pancreatic hepatoid carcinoma (HC) is an extremely uncommon neoplasm of pancreas that resembles hepatocellular carcinoma (HCC). We report a case of incidentally detected pancreatic HC combined with a serous microcystic cystadenoma, in a 47-year-old man, while he was being evaluated for renal calculi. Contrast enhanced computed tomography (CECT) of abdomen revealed a lesion with mild heterogeneous enhancement in the tail of pancreas and another proximal lesion having moderate enhancement, and a calculus in the neck of gallbladder. Serum chromogranin, carcinoembryonic antigen (CEA) and CA 19-9 levels were within normal limits. He underwent laparoscopic distal pancreatectomy with splenectomy and cholecystectomy. Pathologically the distal tumor was encapsulated and characterized by eosinophilic cytoplasm, vesicular nucleus with prominent nucleolus and intranuclear eosinophilic inclusions. The cells were arranged in trabecular pattern separated by sinusoids. Canalicular and intercellular bile plugs were seen. On immunohistochemistry tumor cells were positive for hepatocyte specific antigen and weakly positive for alpha fetoprotein (AFP). The proximal tumor showed features of serous microcystic adenoma. Based on these findings, the case was diagnosed as hepatoid tumor of pancreas combined with serous microcystic cystadenoma. Post operative AFP was 1.75 IU/mL. The patient is on follow up for the last eight months and there is no evidence of recurrence.
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Affiliation(s)
- Fadl H Veerankutty
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Varghese Yeldho
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Shabeer Ali Tu
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - B Venugopal
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Krishnan Sarojam Manoj
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - C Vidhya
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
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9
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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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10
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El-Shahat M, El-Abd S, Alkafafy M, El-Khatib G. Potential chemoprevention of diethylnitrosamine-induced hepatocarcinogenesis in rats: myrrh (Commiphora molmol) vs. turmeric (Curcuma longa). Acta Histochem 2012; 114:421-8. [PMID: 21871653 DOI: 10.1016/j.acthis.2011.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/04/2011] [Accepted: 08/08/2011] [Indexed: 01/26/2023]
Abstract
The aim of the present study was to assess the potential chemopreventive effects of myrrh (Commiphora molmol) vs. turmeric (Curcuma longa) in hepatocarcinogenic rats induced by a single intraperitoneal injection of diethylnitrosamine (DENA) (200 mg/kg body weight). Ninety male Wistar rats used in this study were randomly divided into six equal groups (n=15). Group 1 rats served as negative controls; group 2 received a single i.p. injection of DENA and served as positive controls. Rats in both groups were fed on basal diet. Group 3 rats were fed a diet containing 5% turmeric, whereas group 4 rats were fed a diet containing 2% myrrh. Rats in groups 5 and 6 received a single i.p. injection of DENA and were fed diets containing 5% turmeric and 2% myrrh, respectively. The study demonstrated that DENA caused a significant increase in serum indices of liver enzymes and also severe histological and immunohistochemical changes in hepatic tissues. These included disorganized hepatic parenchyma, appearance of pseudoacinar and trabecular arrays of hepatocytes and alterations in CD10-immunoreactivity. Dietary supplementation of turmeric relatively improved the biochemical parameters to values approximating those of the negative controls and delayed the initiation of carcinogenesis. In contrast, myrrh did not improve the biochemical parameters or delay the hepatocarcinogenesis. Both turmeric and myrrh induced significant biochemical and histological changes in non-treated rats. In conclusion, DENA significantly changes the biological enzymatic activities in serum and the integrity of hepatic tissues. Phytochemicals with potential hepatoprotective effects must be applied cautiously owing to their potential hepatotoxicity.
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11
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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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12
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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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13
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14
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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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15
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Abdullah A, Jenkins-Mosure K, Lewis T, Patel Y, Strobel S, Pepe L. Primary hepatoid carcinoma of the biliary tree: a radiologic mimicker of Klatskin-type tumor. Cancer Imaging 2010; 10:198-201. [PMID: 20934950 PMCID: PMC2999407 DOI: 10.1102/1470-7330.2010.0027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hepatoid carcinomas are a group of neoplasms with features resembling hepatocellular carcinomas. Although extremely rare, more cases have been noted to arise from various organs within the last decade. Differentiating these tumors when located in the biliary tree from cholangiocarcinoma is not only a radiologic challenge but also critical, because treatment modalities and operative strategies are dependent on the exact nature of the tumor. We report a unique case in the literature of a 67-year-old Caucasian female who presented with obstructive jaundice due to an obstructing mass seen at the common hepatic duct on imaging with no preceding history of cirrhosis and increased serum α-fetoprotein (AFP), in whom a differential diagnosis from cholangiocarcinoma in a non-cirrhotic liver was particularly difficult given the combination of tumor location and solitary nature. The radiologist may include ectopic hepatoid adenocarcinomas in the differential consideration of an obstructing tumor in the biliary tree especially in patients with increased serum AFP levels.
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Affiliation(s)
- Asif Abdullah
- Department of Radiology, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614-2598, USA.
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