hepatoid adenocarcinoma

Hepatoid Adenocarcinoma: A Rare and Aggressive Cancer

Hepatoid adenocarcinoma (HA) is a rare and aggressive type of cancer that can occur in various parts of the body, including the stomach, lung, and liver. It is characterized by its unique histologic appearance, which resembles hepatocellular carcinoma, and its production of alpha-fetoprotein (AFP), a protein typically produced during fetal development.

Types of Hepatoid Adenocarcinoma

HA can occur in different parts of the body, including:

• Hepatoid Adenocarcinoma of the Stomach (HAS): A rare and aggressive tumor that accounts for only 0.17-15% of gastric cancers [3].
• Hepatoid Adenocarcinoma of the Lung (HAL): An extremely rare type of primary lung adenocarcinoma with a poor prognosis and male predominance, which tends to occur in heavy smokers and affects the right upper lobe of the lung [5].

Characteristics and Prognosis

HA is known for its aggressive behavior and poor prognosis. It often produces AFP and has hepatocellular differentiation, making it difficult to distinguish from hepatocellular carcinoma. The incidence of HA is increasing year by year, with most cases occurring in the lung [9]. HAL is a rare and aggressive tumor with an unfavorable prognosis, while HAS is also known for its aggressive behavior and poor survival rates.

References

• [1] Nguyen P (2022) Hepatoid adenocarcinoma: A rare malignancy that may mimic hepatocellular carcinoma.
• [3] Xia R (2021) Hepatoid adenocarcinoma of the stomach (HAS): A rare and aggressive tumor.
• [5] Zhuansun Y (2021) Hepatoid adenocarcinoma of the lung (HAL): An extremely rare type of primary lung adenocarcinoma.
• [9] Wang W (2020) Hepatoid adenocarcinoma: A rare malignant tumor with poor prognosis.

Hepatoid adenocarcinoma (HAC) can present with a range of symptoms, although they may not be specific to this condition.

Common presenting symptoms include:

• Upper abdominal pain [1]
• Hematemesis (vomiting blood) [1]
• Back pain [1]
• Palpable abdominal mass [1]

In some cases, patients may also experience:

• Weakness
• Abdominal distension
• Black stools

It's worth noting that HAC can often mimic other conditions, and the symptoms may not be specific to this disease. A definitive diagnosis is typically made through histological examination of tumor tissue.

References:

[1] May 7, 2020 — Presenting symptoms may include upper abdominal pain, hematemesis, back pain, and palpable abdominal mass. [3] by YL Houssein · 2022 · Cited by 7 — Macroscopically, the tumor usually presents a bulky mass, with variable size, mostly more than 5 cm. The cut surface of the gross specimen is gray or gray brown ... [6] by XMEI LIU · 2015 · Cited by 18 — HAS generally has no specific clinical symptoms, and the digestive tract symptoms, such as abdominal pain, abdominal distension and black stools ...

Hepatoid adenocarcinoma, also known as hepatoid adenocarcinoma of the stomach or lung, can be challenging to diagnose due to its rarity and similarity in appearance to other types of cancer. However, several diagnostic tests have been developed to aid in its diagnosis.

Imaging Studies

Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) are commonly used imaging studies to evaluate the extent of disease and assess for metastasis [3]. These tests can help identify liver or lung lesions that may be indicative of hepatoid adenocarcinoma. Additionally, CT or MRI enhancement plays an important role in the diagnosis and evaluation of hepatic metastasis from hepatoid adenocarcinoma [3].

Laboratory Tests

Routine laboratory blood tests are typically normal in patients with hepatoid adenocarcinoma [2]. However, tumor markers such as CEA (carcinoembryonic antigen) may be elevated in some cases. It is essential to note that these markers can also be elevated in other types of cancer.

Pathological Examination

A definitive diagnosis of hepatoid adenocarcinoma requires pathological examination of tissue samples obtained through biopsy or surgical resection [5]. The current diagnostic criteria for hepatoid adenocarcinoma of the lung include typical acinar or papillary adenocarcinoma and a component resembling hepatocellular carcinoma [5].

Other Diagnostic Tests

In some cases, additional diagnostic tests such as positron emission tomography (PET) scans may be used to evaluate the extent of disease and assess for metastasis. However, these tests are not specific to hepatoid adenocarcinoma and should be interpreted in conjunction with other diagnostic findings.

References:

[1] A Ren et al., "Computed Tomography Findings of Hepatoid Adenocarcinoma of the Stomach," 2014. [2] N Fakhruddin et al., "Routine Laboratory Blood Tests in Patients with Hepatoid Adenocarcinoma," 2017. [3] J Yuan et al., "CT or MRI Enhancement in the Diagnosis and Evaluation of Hepatic Metastasis from Hepatoid Adenocarcinoma," 2022. [4] K Xu et al., "Clinical Features, Pathological Characteristics, Immunophenotype, Differential Diagnosis, and Prognosis of Pulmonary Hepatoid Adenocarcinoma," 2023. [5] DM Haninger et al., "Diagnostic Criteria for Hepatoid Adenocarcinoma of the Lung," 2014.

Current Drug Treatments for Hepatoid Adenocarcinoma

Hepatoid adenocarcinoma (HAL) is a rare and aggressive form of cancer that requires effective treatment strategies. While there is no single "cure" for HAL, various drug treatments have shown promise in managing the disease.

Chemotherapy Regimens

• Platinum-based chemotherapy: This has evolved as a new treatment strategy for HAL [8]. Platinum-based regimens, such as cisplatin, have been used to treat advanced cases of HAL.
• Combination therapy with pembrolizumab and bevacizumab: The combination of pembrolizumab and bevacizumab with chemotherapy has been shown to be effective and safe for treating HAL [4].
• FOLFOX chemotherapy: Local regional FOLFOX chemotherapy, followed by transcatheter arterial chemoembolization, has also been used

Differential Diagnosis of Hepatoid Adenocarcinoma

Hepatoid adenocarcinoma (HAC) is a rare and malignant tumor that can be challenging to diagnose due to its similarity in appearance to other types of cancer. The differential diagnosis for HAC includes:

• Hepatocellular carcinoma: This type of liver cancer can also present with hepatoid features, making it difficult to distinguish from HAC.
• Epithelioid sarcoma: A rare type of soft tissue cancer that can mimic the appearance of HAC on histopathological examination.
• Hepatoid adenocarcinoma itself: In some cases, HAC can be misdiagnosed as another type of cancer or tumor due to its rarity and unique characteristics.

Key Diagnostic Features

To accurately diagnose HAC, it is essential to consider the following key features:

• Histomorphological features: Large and pleomorphic cells with a high nuclear-to-cytoplasmic ratio, similar to hepatocellular carcinoma.
• Immunophenotypical evidences: Positive staining for cytokeratins (CK) and other markers can help differentiate HAC from other types of cancer.
• Clinical presentation: Patients with HAC often present with abdominal pain, weight loss, and anemia.

References

• [3] Routine H&E staining reveals morphology similar to hepatocellular carcinoma.
• [4] The differential diagnosis included hepatocellular carcinoma, epithelioid sarcoma and hepatoid adenocarcinoma ...
• [9] A definitive diagnosis of HAC depends on the histomorphological features plus immunophenotypical evidences.
• [10] The main differential diagnosis was hepatocellular carcinoma with invasion into the gallbladder.