8576/3 Hepatoid adenocarcinoma


Synonyms

Hepatoid carcinoma

Definitions

Region of the ampulla of Vater
ICD-O-3 topography code: C24.1
ICD10: C24.1
           

An adenocarcinoma with morphologic characteristics similar to hepatocellular carcinoma arising from an anatomic site other than the liver.

Hepatoid adenocarcinoma of the ampulla of Vater
Fewer than five cases of hepatoid adenocarcinoma of the ampulla have been reported to date 1
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Gardiner GW, Lajoie G, Keith R (1992)
Hepatoid adenocarcinoma of the papilla of Vater.
Histopathology 20: 541-4



2
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Sato Y, Tominaga H, Tangoku A, Hamanaka Y, Yamashita Y, Suzuki T (1992)
Alpha-fetoprotein-producing cancer of the ampulla of Vater.
Hepatogastroenterology 39: 566-9



. As its name implies, this neoplasm consists of an adenocarcinoma, usually with an intestinal phenotype, as well as cells closely resembling hepatocytes that grow in sheets or cords. The latter cells are polygonal with abundant eosinophilic cytoplasm are immunoreactive for α-fetoprotein, HepPar1 antibody and polyclonal CEA in a canalicular pattern. Bile pigment has occasionally been identified.



Stomach
ICD-O-3 topography code: C16
ICD10: C16
           

An adenocarcinoma with morphologic characteristics similar to hepatocellular carcinoma, arising from an anatomic site other than the liver.

Hepatoid adenocarcinoma of the stomach is composed of large polygonal eosinophilic hepatocyte-like neoplastic cells. α-Fetoprotein (AFP) can be detected in situ, but also in the serum. Bile and periodic acid-Schiff (PAS)- positive and diastase-resistant intracytoplasmic eosinophilic globules can be observed
3
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



. Other rare AFP-producing carcinomas include well-differentiated papillary or tubular-type adenocarcinoma with clear cytoplasm and yolk-sac tumour-like carcinoma 4
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Inagawa S, Shimazaki J, Hori M, Yoshimi F, Adachi S, Kawamoto T, Fukao K, Itabashi M (2001)
Hepatoid adenocarcinoma of the stomach.
Gastric Cancer 4: 43-52



5
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Ishikura H, Kirimoto K, Shamoto M, Miyamoto Y, Yamagiwa H, Itoh T, Aizawa M (1986)
Hepatoid adenocarcinomas of the stomach. An analysis of seven cases.
Cancer 58: 119-26



6
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Motoyama T, Aizawa K, Watanabe H, Fukase M, Saito K (1993)
alpha-Fetoprotein producing gastric carcinomas: a comparative study of three different subtypes.
Acta Pathol Jpn 43: 654-61



7
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Nagai E, Ueyama T, Yao T, Tsuneyoshi M (1993)
Hepatoid adenocarcinoma of the stomach. A clinicopathologic and immunohistochemical analysis.
Cancer 72: 1827-35



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Ovary
ICD-O-3 topography code: C56
ICD10: C56
           

An adenocarcinoma with morphologic characteristics similar to hepatocellular carcinoma, arising from an anatomic site other than the liver.



Pancreas
ICD-O-3 topography code: C25
ICD10: C25
           

An adenocarcinoma with morphologic characteristics similar to hepatocellular carcinoma, arising from an anatomic site other than the liver.

Hepatoid carcinoma of the pancreas
This is an extremely rare malignant epithelial neoplasm with a significant component of hepatocellular differentiation. Hepatoid differentiation can occur in a pure form, or in association with a ductal adenocarcinoma, an acinar or a neuroendocrine neoplasm
8
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Hughes K, Kelty S, Martin R (2004)
Hepatoid carcinoma of the pancreas.
Am Surg 70: 1030-3



9
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Paner GP, Thompson KS, Reyes CV (2000)
Hepatoid carcinoma of the pancreas.
Cancer 88: 1582-9



10
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Tanno S, Obara T, Fujii T, Izawa T, Mizukami Y, Saitoh Y, Ura H, Kohgo Y (1999)
alpha-Fetoprotein-producing adenocarcinoma of the pancreas presenting focal hepatoid differentiation.
Int J Pancreatol 26: 43-7



11
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Yano T, Ishikura H, Wada T, Kishimoto T, Kondo S, Katoh H, Yoshiki T (1999)
Hepatoid adenocarcinoma of the pancreas.
Histopathology 35: 90-2



.
Hepatoid carcinomas are composed of large polygonal cells with abundant eosinophilic cytoplasm. Most express α- fetoprotein (AFP); however, AFP secretion can also be observed in pancreatoblastomas and in acinar, neuroendocrine, and ductal neoplasms without hepatoid features
12
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Cingolani N, Shaco-Levy R, Farruggio A, Klimstra DS, Rosai J (2000)
Alpha-fetoprotein production by pancreatic tumors exhibiting acinar cell differentiation: study of five cases, one arising in a mediastinal teratoma.
Hum Pathol 31: 938-44



13
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Kawamoto S, Hiraoka T, Kanemitsu K, Kimura M, Miyauchi Y, Takeya M (1992)
Alpha-fetoprotein-producing pancreatic cancer--a case report and review of 28 cases.
Hepatogastroenterology 39: 282-6



. The expression of hepatocyte-specific antigen (hepatocyte paraffin-1) is more specific for hepatocellular differentiation. A canalicular pattern of labelling with antibodies to polyclonal CEA and CD10 can help establish the diagnosis in some cases 14
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Cuilliere P, Lazure T, Bui M, Fabre M, Buffet C, Gayral F, Bedossa P (2002)
Solid adenoma with exclusive hepatocellular differentiation: a new variant among pancreatic benign neoplasms?
Virchows Arch 441: 519-22



15
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Hameed O, Xu H, Saddeghi S, Maluf H (2007)
Hepatoid carcinoma of the pancreas: a case report and literature review of a heterogeneous group of tumors.
Am J Surg Pathol 31: 146-52



.
Hepatocellular carcinoma arising from ectopic liver tissue should not be included in this category. Pancreatic metastases from an occult hepatocellular carcinoma are probably much more common than are primary hepatoid carcinomas of the pancreas, and a metastasis to the pancreas needs to be excluded, usually on clinical grounds, before establishing the diagnosis of a hepatoid carcinoma primary to the pancreas.
Data on the prognosis of hepatoid carcinomas are minimal
16
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



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