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Huang X, Guo X, Yu Y. Case report and literature analysis: pancreatic hepatoid carcinoma with multiple lymph node metastases progressing to liver metastasis after pancreaticoduodenectomy. Front Oncol 2024; 14:1335647. [PMID: 38737909 PMCID: PMC11082267 DOI: 10.3389/fonc.2024.1335647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/05/2024] [Indexed: 05/14/2024] Open
Abstract
Hepatoid carcinoma is an extrahepatic primary tumor displaying characteristics reminiscent of hepatocellular carcinoma differentiation, which is found in various organs, such as the stomach, ovaries, gallbladder, and pancreas. Reports of pancreatic hepatoid carcinoma remain scarce. Consequently, understanding of this disease remains a priority, with no established consensus on its diagnosis and management. Here, we reported the case of a 45-year-old woman diagnosed with hepatoid carcinoma located in the pancreatic head, accompanied by multiple lymph node metastases. Following pancreaticoduodenectomy, the patient developed liver metastases within 3 months. Subsequently, she underwent adjuvant therapy consisting of Teysuno and Durvalumab following microwave ablation for the liver metastases. Remarkably, the patient has survived for one year without significant disease progression. This case underscores the potential efficacy of immunotherapy as a promising treatment option for pancreatic hepatoid carcinoma. Further research and clinical trials are warranted to explore the optimal management strategies for this rare and challenging malignancy.
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Affiliation(s)
- Xiaorui Huang
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinyi Guo
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yahong Yu
- Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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2
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Buiron C, Grange R, Rousset P, Villeneuve L, Benzerdjeb N, Glehen O, Kepenekian V. Primary Peritoneal Hepatoid Adenocarcinoma Patients Treated by Complete Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Indian J Surg Oncol 2023; 14:151-160. [PMID: 37359928 PMCID: PMC10284782 DOI: 10.1007/s13193-023-01737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Hepatoid adenocarcinoma (HAC) is an extremely rare disease, which could develop from any thoraco-abdominal organ and which exhibits features mimicking hepatocellular carcinoma (HCC). Its diagnosis is thus highly challenging, so is the treatment of that disease. So far, 12 cases have been reported in the literature as issued from the peritoneum. These primary peritoneal HAC were associated with a dismal prognosis and heterogenous management. Two additional cases were described here, managed in a multidisciplinary way as rare peritoneal surface malignancies in an expert center, following the strategy based on a comprehensive tumor burden extension assessment and a radical approach combining iterative complete cytoreductive surgeries followed by hyperthermic intra-peritoneal chemotherapy (HIPEC) and limited systemic chemotherapy sequences. In particular, the choline PET-CT scan guided surgical exploration to reach a complete resection. The oncologic outcomes were promising with a first patient dying 111 months after the diagnosis and a second patient still alive at 43 months.
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Affiliation(s)
- Charles Buiron
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
- EA3738 CICLY, Université Claude Bernard Lyon, 1 (UCBL1), Lyon, France
| | - Remi Grange
- EA3738 CICLY, Université Claude Bernard Lyon, 1 (UCBL1), Lyon, France
- Department of Radiology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Pascal Rousset
- EA3738 CICLY, Université Claude Bernard Lyon, 1 (UCBL1), Lyon, France
- Department of Radiology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | | | - Nazim Benzerdjeb
- EA3738 CICLY, Université Claude Bernard Lyon, 1 (UCBL1), Lyon, France
- Department of Pathology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Olivier Glehen
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
- EA3738 CICLY, Université Claude Bernard Lyon, 1 (UCBL1), Lyon, France
| | - Vahan Kepenekian
- Surgical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
- EA3738 CICLY, Université Claude Bernard Lyon, 1 (UCBL1), Lyon, France
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3
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Hirabayashi K, Saika T, Nakamura N. Background features in the cytology of pancreatic neoplasms. DEN OPEN 2022; 2:e105. [PMID: 35873514 PMCID: PMC9302047 DOI: 10.1002/deo2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/05/2022]
Abstract
Cytology is a useful method for diagnosing pancreatic neoplasms. Although endoscopic ultrasound‐guided fine‐needle aspiration has recently become the mainstream method for the diagnosis of pancreatic neoplasms, pancreatic juice and pancreatic duct brushing cytology continue to be useful diagnostic methods for the investigation of pancreatic neoplasms. Diagnoses using pancreatic cytology are primarily based on the features related to tumor cells; however, evaluation of the background features provides important information that could further aid the diagnosis. Pancreatic neoplasms show various histological types, each of which is associated with its own characteristic background features. The necrotic background, desmoplastic stroma, and presence of cancer‐associated fibroblasts are background features of pancreatic ductal adenocarcinoma, a mucinous background is associated with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, and hyaline globules are observed in solid pseudopapillary neoplasms. However, some background features are associated with more than one histological type of pancreatic neoplasm, highlighting the importance to base a diagnosis on the results of a comprehensive analysis of not only the background features but also the tumor cells. Here, we provide a review of the key background cytological features of pancreatic neoplasms, which can serve as a guide to improve diagnosis and research.
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Affiliation(s)
| | - Tsubasa Saika
- Diagnostic Pathology Center Tokai University Hospital Kanagawa Japan
| | - Naoya Nakamura
- Department of Pathology Tokai University School of Medicine Kanagawa Japan
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4
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Liu Q, Li J, Pan Y, Zheng X, Gao B. Challenge in Diagnosis and Treatment of Ectopic Hepatocellular Carcinoma: A Case Report and Literature Review. Front Surg 2022; 9:827006. [PMID: 35433804 PMCID: PMC9008362 DOI: 10.3389/fsurg.2022.827006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Findings of ectopic hepatocellular carcinoma (EHCC) have been rarely documented. Complicated clinical features and unpredictable medical prognosis make diagnosis and treatment difficult. Case Presentation We reported a 59-year-old male patient who came to the hospital with epigastric discomfort and regurgitation of gastric acid. An enhanced CT scan revealed a 1.8 cm × 1.4 cm mass in the tail of pancreas without any positive finding in the liver. Postoperative MRI scan was performed but did not reveal any evidence of hepatic tumor. The tumor was resected in toto. Meanwhile, a 1 cm × 1 cm mass in the body of the stomach was found that was removed simultaneously. Histopathology showed that the pancreatic tumor was ectopic hepatocellular carcinoma (EHCC), and that the gastric nodule was gastrointestinal stromal tumor (GIST). The patient had an uneventful postoperative recovery. He has been living without recurrence for over 7 years since surgery. Owing to our knowledge, this is the second-longest disease-free survival time for EHCC in the literature. Conclusion Here, we present a rare case of EHCC in the pancreas, and review the current literature on EHCC. Operation was an effective treatment for patients with curable EHCC. EHCC with metastasis still needs more practice to improve the poor prognosis.
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Affiliation(s)
- Qicen Liu
- Department of General Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyi Li
- Department of Emergency Intensive Care Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yi Pan
- Department of Pathology, Huangshan People's Hospital, Huangshan, China
| | - Xiang Zheng
- Department of Chronic Wound Diagnosis and Treatment Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xiang Zheng
| | - Bin Gao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Bin Gao
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5
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Li M, Fan Y, Lu H. Hepatoid Adenocarcinoma of the Lung. Technol Cancer Res Treat 2021; 20:15330338211057983. [PMID: 34816785 PMCID: PMC8646196 DOI: 10.1177/15330338211057983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hepatoid adenocarcinoma of the lung (HAL) is an comparatively rare malignant tumor originating from the lung with shorter survival. HAL morphologically and pathologically exhibits hepatocellular carcinoma (HCC)-like characteristics, while its clinical features resemble pulmonary adenocarcinoma. High concentration of alpha-fetoprotein (AFP) is often detected in the serum of HAL patients with no hepatic occupying lesion. Patients with AFP-negative HAL survive a few months longer than those with positive AFP test. HAL is a rare type of carcinoma, so there is a lack of systematic and extensive statistical research. The treatment strategy for HAL is similar to common lung adenocarcinoma. Complete surgical resection and adjuvant chemotherapy are the current major treatments for HAL patients. There are also a few of case reports suggesting that HAL patients may benefit from immunotherapy and targeted therapy. This review focuses on the clinical and pathological features, immunohistochemical staining characteristics, treatment and prognosis of HAL.
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Affiliation(s)
- Meihui Li
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, P.R. China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, P.R. China
| | - Ying Fan
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, P.R. China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, P.R. China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, P.R. China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, P.R. China
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Li Z, Zhou Q, Lu J, Zhang H, Teng L. Carcinosarcoma of the stomach with alpha-fetoprotein-producing hepatoid adenocarcinoma: an unexpected combination of two rare subtypes of gastric cancer in one tumor. J Int Med Res 2021; 49:3000605211037422. [PMID: 34407682 PMCID: PMC8381432 DOI: 10.1177/03000605211037422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Carcinosarcoma is a rare malignant neoplasm comprising both epithelial and
mesenchymal components. Hepatoid adenocarcinoma (HAC) is another rare type of
cancer. To date, there are only four reported cases of concurrent
carcinosarcomas with HAC across all tumor types, all of which were observed in
uterine tumors. Here, we report an unusual case of gastric carcinosarcoma
associated with alpha-fetoprotein (AFP)-producing HAC in a 76-year-old woman.
Upon admission, the patient had an elevated serum AFP concentration (448 µg/L),
a necrotic polypoid tumor of the central gastric cardia revealed by endoscopy,
and no evidence of distant metastasis indicated by computed tomography (CT).
Owing to malignancy indicated by biopsy, the patient underwent proximal subtotal
gastrectomy. The resected tumor was composed of both an HAC component and a
sarcoma component, microscopically. The sample was positive for AFP, hepatocyte
paraffin (Hep-Par) 1, glypican-3, SALL4, CDX2, cytokeratin (CK) (pan), CK18,
desmin, and vimentin staining immunohistochemically. In summary, the tumor was
diagnosed as carcinosarcoma of the stomach with AFP-producing HAC. To our
knowledge, this is the first report of gastric carcinosarcoma with AFP-producing
HAC in the English literature describing gastric tumors.
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Affiliation(s)
- Zhongqi Li
- Department of Surgical Oncology, 26441Zhejiang University School of Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quan Zhou
- Department of Surgical Oncology, 26441Zhejiang University School of Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Lu
- Department of Surgical Oncology, 26441Zhejiang University School of Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibin Zhang
- Department of Surgical Oncology, 26441Zhejiang University School of Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lisong Teng
- Department of Surgical Oncology, 26441Zhejiang University School of Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Mixed pancreatic hepatoid carcinoma: A surgical case report and literature review. Int J Surg Case Rep 2021; 83:105951. [PMID: 33971555 PMCID: PMC8129926 DOI: 10.1016/j.ijscr.2021.105951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Hepatoid carcinoma (HC) is a rare type of malignant tumor that shared similar features of morphology and immunohistochemistry with hepatocellular carcinoma (HCC). Pancreatic HC exists as either pure or mixed type. Mixed pancreatic HC is extremely rare, with only a few cases reported in the literature to date. Because of the rarity of mixed pancreatic HC, its clinical features including incidence, characteristics, and prognosis remain unclear. We herein report a case of a 49-year-old man who was diagnosed with mixed pancreatic HC with neuroendocrine differentiation and was treated with pancreaticoduodenectomy and adjuvant chemotherapy. We also review the existing case reports in literature. PRESENTATION A 49-year-old man was admitted to our hospital after a chronic abdominal pain in the upper right quadrant. Abdominal ultrasound revealed only one low-density retroperitoneal mass measured at 20 × 48mm in size in the pancreatic-duodenal junction, whereas contrast-enhanced computed tomography (CT) revealed three lymphatic neoplasms measured at 28 × 22 × 30 mm, 27 × 33 × 38 mm and 22 × 35 × 48 mm in size in the retroperitoneal pancreatic-duodenal junction. Ultrasound-guided tumor biopsy was performed. Pathological reading of tumor biopsy suspected of Paraganglioma/pheochromocytoma. Laparotomic retroperitoneal tumoral resection and lymphadenectomy was then performed. Histological reading was lymphatic metastasis of primary pancreatic hepatocellular carcinoma with neuroendocrine differentiation, which were immunohistochemically positive for CKAE1/AE3, Hepatocyte paraffin 1, Chromogranin. After three weeks of the first surgery, the patient was assigned with Positron Emission Tomography - Computed Tomography (PET-CT) before adjuvant chemotherapy, revealing a low-density high-metabolism mass, 26 × 28 mm in size within the parenchyma of pancreatic head. Laparotomic pancreaticoduodenectomy and standard lymphadenectomy was performed to resect one mass, which revealed the same immunohistology features with the first mass. The patient was followed up with FOLFIRINOX protocol, and after 12 cycles, there was no evidence of postoperative recurrence. DISCUSSION There are few reported cases describing pancreatic hepatoid carcinoma, especially mixed form with other histological associated component. Neuroendocrine differentiation is the majority associated component with 62.5% of all cases of mixed - type form. CONCLUSION Primary pancreatic hepatocellular carcinoma with neuroendocrine differentiation was rare, biopsy and immunohistochemistry appeared with high diagnostic value in this case. The prognosis of pancreatic HC depends on the extent and tumor eradication, and in this case we recorded no postoperative complications and no recurrence in the 6-month follow-up period.
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8
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Schawkat K, Manning MA, Glickman JN, Mortele KJ. Pancreatic Ductal Adenocarcinoma and Its Variants: Pearls and Perils. Radiographics 2020; 40:1219-1239. [PMID: 32678699 DOI: 10.1148/rg.2020190184] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC), an epithelial neoplasm derived from the pancreatic ductal tree, is the most common histologic type of pancreatic cancer and accounts for 85%-95% of all solid pancreatic tumors. As a highly lethal malignancy, it is the seventh leading cause of cancer death worldwide and is responsible for more than 300 000 deaths per year. PDAC is highly resistant to current therapies, affording patients a 5-year overall survival rate of only 7.2%. It is characterized histologically by its highly desmoplastic stroma embedding tubular and ductlike structures. On images, it typically manifests as a poorly defined hypoenhancing mass, causing ductal obstruction and vascular involvement. Little is known about the other histologic subtypes of PDAC, mainly because of their rarity and lack of specific patterns of disease manifestation. According to the World Health Organization, these variants include adenosquamous carcinoma, colloid carcinoma, hepatoid carcinoma, medullary carcinoma, signet ring cell carcinoma, undifferentiated carcinoma with osteoclast-like giant cells, and undifferentiated carcinoma. Depending on the subtype, they can confer a better or even worse prognosis than that of conventional PDAC. Thus, awareness of the existence and differentiation of these variants on the basis of imaging and histopathologic characteristics is crucial to guide clinical decision making for optimal treatment and patient management.
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Affiliation(s)
- Khoschy Schawkat
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Maria A Manning
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Jonathan N Glickman
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Koenraad J Mortele
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
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Tan Y, Min J, Yang F, Zhang B, Li J. A 60-Year-Old Man With Right Lung Mass Presents With Cough. Chest 2019; 156:e137-e143. [PMID: 31812213 DOI: 10.1016/j.chest.2019.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/26/2019] [Accepted: 07/27/2019] [Indexed: 12/16/2022] Open
Abstract
CASE PRESENTATION A 60-year-old Chinese man was admitted to our hospital with chronic cough for > 2 months. His cough was paroxysmal and nonirritating, occasionally productive with some small amounts of white phlegm. He had had a low-grade fever for half a month. There were no night sweats, joint swelling on limbs, pain, rash, or any other discomfort. The patient denied weight loss and decreased appetite.
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Affiliation(s)
- Yanbin Tan
- Department of Radiology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China.
| | - Jie Min
- Department of Radiology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Fan Yang
- Department of Radiology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Bin Zhang
- Department of Respiration, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Jinfan Li
- Department of Pathology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
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10
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Tomino T, Ninomiya M, Matono R, Narutomi F, Oshiro Y, Watanabe K, Taniguchi D, Nishimura S, Zaitsu Y, Kajiwara Y, Yokota T, Minami K, Nishizaki T. Pure pancreatic hepatoid carcinoma: a surgical case report and literature review. Surg Case Rep 2019; 5:186. [PMID: 31784920 PMCID: PMC6884606 DOI: 10.1186/s40792-019-0723-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background Hepatoid carcinoma (HC) is an extra-hepatic neoplasm that shares the morphological and immunohistochemical features of hepatocellular carcinoma. Pancreatic HC exists as either pure or combined type. Pure pancreatic HC is extremely rare, with only a few cases reported in the literature to date. Because of the rarity of pure pancreatic HC, its clinical features including incidence, behavior, and prognosis remain unclear. We herein report the case of a 56-year-old man who developed pure pancreatic HC treated with surgical resection. We also include a review of the existing literature. Case presentation A 56-year-old male patient was admitted to our hospital after a pancreatic cyst was identified by abdominal ultrasonography on a comprehensive medical examination. Endoscopic ultrasound revealed a cystic mass measuring 13 mm in size in the pancreatic head and a low-density mass measuring 16 mm in size in the pancreatic tail, which was partially enhanced on contrast-enhanced ultrasound. Contrast-enhanced computed tomography (CT) revealed a branch duct type intraductal papillary mucinous neoplasm in the pancreatic head and an early enhanced nodule measuring approximately 10 mm in size in the pancreatic tail. Endoscopic ultrasound-guided fine-needle aspiration of the hypervascular tumor was performed. The hypervascular tumor was suspected to be a solid pseudopapillary neoplasm. Laparoscopic spleen-preserving distal pancreatectomy was performed. Histology was identical to hepatocellular carcinoma of the liver. Immunohistochemically, the tumor cells were positive for hepatocyte paraffin 1, and a canalicular pattern was confirmed on the polyclonal carcinoembryonic antigen staining. The patient was diagnosed with a moderately differentiated pancreatic HC. The patient was followed up without adjuvant chemotherapy, and there was no evidence of recurrence at 6 months post-operatively. Conclusions We present a case of moderately differentiated pure pancreatic HC. For the accurate preoperative diagnosis of pure pancreatic HC, biopsy is preferred to cytology or preoperative imaging studies such as CT. The prognosis of pure pancreatic HC depends on its differentiation.
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Affiliation(s)
- Takahiro Tomino
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan.
| | - Mizuki Ninomiya
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Rumi Matono
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Fumiya Narutomi
- Department of Diagnostic Pathology, Matsuyama Red Cross Hospital, Matsuyama-shi, Ehime, Japan
| | - Yumi Oshiro
- Department of Diagnostic Pathology, Matsuyama Red Cross Hospital, Matsuyama-shi, Ehime, Japan
| | - Kenji Watanabe
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Daisuke Taniguchi
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Sho Nishimura
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Yoko Zaitsu
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Yuichiro Kajiwara
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Tomoyuki Yokota
- Department of Center for Liver and Biliary and Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama-shi, Ehime, Japan
| | - Kazuhito Minami
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
| | - Takashi Nishizaki
- Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-shi, Ehime, 790-8524, Japan
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Abstract
RATIONALE Hepatoid adenocarcinoma of lung (HAL) is a rare malignant tumor, which can be defined as a primary alpha-fetoprotein (AFP)-producing lung carcinoma. The majority of hepatoid adenocarcinoma (HAC) expressed AFP in tumor cells, but AFP expression is not required for its diagnosis according to the modified diagnostic criteria. Despite that HAC exhibits a poor prognosis and ineffective treatment options, early diagnosis and aggressive treatment can result in long-term survival. PATIENT CONCERNS We report a 70-year-old Chinese male patient with alcoholic intake over 30 years and smoking history of 60 cigarettes per day for 40 years. He sought medical consultation for productive cough and hemoptysis sputum. DIAGNOSES AND INTERVENTIONS Chest CT scan revealed a mass (6.4 × 5.5 cm) in the left lower lobe of the lung. The patient underwent curative surgical resection, and subsequently diagnosed as HAL. OUTCOMES Eighteen months after primary diagnosis, the patient died of multiple organ failure caused by distant metastases. LESSONS Familiarizing with the clinical features and modified diagnostic criteria of this rare tumor may increase awareness of the disease among clinicians and pathologists, thereby avoiding misdiagnosis and mistreatment.
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Affiliation(s)
- Kun Yang
- Central Laboratory, Affiliated Hospital of Qingdao university
| | - Huifeng Jiang
- Department of Pathology, Qilu Hospital, Shandong University, Qingdao, China
| | - Qiuyao Li
- Department of Pathology, Qilu Hospital, Shandong University, Qingdao, China
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12
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Yang C, Sun L, Lai JZ, Zhou L, Liu Z, Xi Y, Tao Y, Dooley E, Cao D. Primary Hepatoid Carcinoma of the Pancreas: A Clinicopathological Study of 3 Cases With Review of Additional 31 Cases in the Literature. Int J Surg Pathol 2019; 27:28-42. [PMID: 29961402 DOI: 10.1177/1066896918783468] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Primary pancreatic hepatoid carcinoma (PHC) is very rare. Here, we reported 3 such cases with review of additional 31 cases in the literature. Our 3 patients were male (83, 72, and 54 years old, respectively). Serum α-fetoprotein (AFP) was elevated in 1 patient (case 3, 8338 ng/mL) and not measured in the other two. The PHC in patient 1 (pathological stage pT2N0M0) and patient 2 (pT3N0M0) showed pure hepatocellular carcinoma (HCC)-like morphology, whereas in case 3 it was a PHC with true glandular differentiation (pT4N0M0). The diagnosis of PHC was confirmed with positive immunohistochemical staining in the tumor cells for AFP (2/3), Hep Par 1 (3/3), glypican-3 (2/3), arginase-1 (2/3), and Sal-like protein 4 (1/3). CD10 and polyclonal carcinoembryonic antigen stains show focal canalicular pattern in 2/3 tumors. Patient 1 did not receive further treatment after resection and was alive with no evidence of disease at 107 months. Patient 2 died of postoperative complications, whereas patient 3 received postsurgical chemoradiation and died of disease at 29 months. Our findings and literature review indicate that PHCs can be divided into 4 histological subtypes: with pure HCC-like morphology (n = 22), with neuroendocrine differentiation (n = 8), with true glandular differentiation (n = 3), and with acinar cell differentiation (n = 1). On univariate analysis, pure HCC-like morphology was associated with better disease-specific survival (DSS; P = .04), whereas lymph node and distant metastases were associated with worse DSS ( P = .002 for both). Age, gender, presenting symptoms, serum AFP level, and T stage were not associated with DSS. On multivariate analysis, none of these parameters was significantly associated with DSS.
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Affiliation(s)
- Chen Yang
- 1 Washington University School of Medicine, St Louis, MO, USA
| | - Li Sun
- 2 Peking University Cancer Hospital and Institute, Beijing, China
| | - Jenny Z Lai
- 3 Washington University in St Louis, MO, USA
| | - Lixin Zhou
- 2 Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhen Liu
- 2 Peking University Cancer Hospital and Institute, Beijing, China
| | - Yanfeng Xi
- 4 Shanxi Medical University, Taiyuan, China
| | - Yu Tao
- 1 Washington University School of Medicine, St Louis, MO, USA
| | | | - Dengfeng Cao
- 1 Washington University School of Medicine, St Louis, MO, USA
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13
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Valentino F, Torchio M, Morbini P, Danova M. Synchronous Presentation of Hepatoid Alpha-Fetoprotein-Producing Lung Cancer and Colorectal Adenocarcinoma. TUMORI JOURNAL 2018. [DOI: 10.1177/030089161209800523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the synchronous presentation of hepatoid adenocarcinoma of the lung and colorectal adenocarcinoma in a patient with elevated alpha-fetoprotein (AFP) serum levels. Our patient was treated after surgery with a conventional chemotherapy regimen including bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody, which was demonstrated to improve the clinical results in the treatment of colorectal and lung cancer compared with chemotherapy alone, and is today approved both for colon and lung cancer. Besides the unconventional association of the two cancer types in our patient and the unsatisfactory clinical benefit obtained with the medical treatment administered, we report on the significance of AFP serum levels as a tumor marker in this peculiar situation. In our patient these levels, monitored from the first clinical symptoms through the last chemotherapy course, did not show any correlation with the response to treatment or with the patient's overall outcome. In particular, the serum marker remained essentially unchanged after the surgical removal of the lung mass and the subsequent chemotherapy.
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Affiliation(s)
- Francesco Valentino
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Martina Torchio
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Morbini
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Danova
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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14
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Metastatic Hepatoid Carcinoma of the Pancreas: First Description of Treatment With Capecitabine and Temozolomide. Am J Med Sci 2016. [PMID: 28641727 DOI: 10.1016/j.amjms.2016.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Chang JM, Katariya NN, Lam-Himlin DM, Haakinson DJ, Ramanathan RK, Halfdanarson TR, Borad MJ, Pannala R, Faigel D, Moss AA, Mathur AK. Hepatoid Carcinoma of the Pancreas: Case Report, Next-Generation Tumor Profiling, and Literature Review. Case Rep Gastroenterol 2016; 10:605-612. [PMID: 27920649 PMCID: PMC5121547 DOI: 10.1159/000448064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/28/2016] [Indexed: 12/12/2022] Open
Abstract
Fewer than 25 cases of hepatoid carcinoma of the pancreas have been reported in the literature. We present a case in a 61-year-old male with a remote history of Hodgkin's lymphoma and gastric neuroendocrine cell hyperplasia. On surveillance endoscopic ultrasound, an 8 × 5 mm cystic lesion was seen in the tail of the pancreas. MRI showed a focal pancreatic duct cut-off with mild ductal dilation. Fine needle aspiration was performed, which was concerning for acinar cell carcinoma. The patient underwent distal pancreatectomy and recovered uneventfully. Final pathology demonstrated a 1.3-cm hepatoid carcinoma of the pancreas, with a final clinicopathological stage of T1N0M0. Next-generation nucleic acid sequencing of the tumor did not suggest a viable adjuvant chemotherapeutic agent, and no adjuvant therapy was administered. The patient has no evidence of disease 6 months following resection. A further characterization and description of the outcomes of these rare tumors is warranted to help guide providers and counsel patients.
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Affiliation(s)
- James M Chang
- Division of Transplant and Hepatopancreatobiliary Surgery, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Nitin N Katariya
- Division of Transplant and Hepatopancreatobiliary Surgery, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Dora M Lam-Himlin
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Danielle J Haakinson
- Division of Transplant and Hepatopancreatobiliary Surgery, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | | | | | - Mitesh J Borad
- Division of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Rahul Pannala
- Division of Gastroenterology/Hepatology, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Douglas Faigel
- Division of Gastroenterology/Hepatology, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Adyr A Moss
- Division of Transplant and Hepatopancreatobiliary Surgery, Mayo Clinic Arizona, Phoenix, Ariz., USA
| | - Amit K Mathur
- Division of Transplant and Hepatopancreatobiliary Surgery, Mayo Clinic Arizona, Phoenix, Ariz., USA
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16
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Akimoto Y, Kato H, Matsumoto K, Harada R, Oda S, Fushimi S, Mizukawa S, Yabe S, Uchida D, Seki H, Tomoda T, Yamamoto N, Horiguchi S, Tsutsumi K, Yagi T, Okada H. Pancreatic Hepatoid Carcinoma Mimicking a Solid Pseudopapillary Neoplasm: A Challenging Case on Endoscopic Ultrasound-guided Fine-needle Aspiration. Intern Med 2016; 55:2405-11. [PMID: 27580541 DOI: 10.2169/internalmedicine.55.6741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 59-year-old man was admitted to our hospital for treatment of a 45 mm pancreatic mass found during a medical examination. Endoscopic ultrasound-guided fine-needle aspiration cytology showed polygonal cells with pseudopapillary structures. The tumor cells were positive for nuclear/cytoplasmic β-catenin and CD10, and negative for chromogranin A. After a tentative diagnosis of a solid pseudopapillary neoplasm, middle pancreatectomy was performed. Histologically, polygonal cells with abundant eosinophilic cytoplasm formed in the trabeculae and were immunohistochemically positive for HepPar1 and protein induced by vitamin K absence or antagonist-II. The tumor was finally diagnosed to be pancreatic hepatoid carcinoma. No recurrence occurred for 12 months, even without adjuvant chemotherapy.
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Affiliation(s)
- Yutaka Akimoto
- Department of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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17
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Hepatoid Adenocarcinoma of the Lung: A Case Report and Literature Review. J Gastrointest Cancer 2016; 43 Suppl 1:S125-7. [PMID: 21894458 DOI: 10.1007/s12029-011-9318-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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18
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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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19
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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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20
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Vanoli A, Argenti F, Vinci A, La Rosa S, Viglio A, Riboni R, Necchi V, Pugliese L, Sessa F, Pietrabissa A, Paulli M. Hepatoid carcinoma of the pancreas with lymphoid stroma: first description of the clinical, morphological, immunohistochemical, and molecular characteristics of an unusual pancreatic carcinoma. Virchows Arch 2015; 467:237-45. [PMID: 25989715 DOI: 10.1007/s00428-015-1788-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/07/2015] [Accepted: 05/11/2015] [Indexed: 12/27/2022]
Abstract
We report a case of tumour in the head of the pancreas observed in a 57-year-old man with a history of worsening jaundice and elevated alpha-fetoprotein (AFP) serum level, who underwent Whipple pancreatoduodenectomy. Histologically, the tumour was predominantly composed of solid sheets of large eosinophilic cells with a prominent lymphoid infiltration without association neither with DNA microsatellite instability nor Epstein-Barr virus infection. The tumour was diffusely and strongly positive for hepatocyte paraffin-1 (Hep Par-1) and glypican-3 leading to the diagnosis of hepatoid carcinoma. Strong cytoplasmic staining for AFP was focally observed. Moreover, tumour cells showed countless cytoplasmic eosinophilic globules immunoreactive for the stress protein p62. A primary hepatocellular carcinoma of the liver was ruled out by careful clinical analysis. Hepatoid carcinoma is an extremely rare pancreatic neoplasm, and here, we describe the first case of such variant associated with lymphoid stroma. The characteristic histologic features and the immunophenotypic profile help in distinguishing this carcinoma from other pancreatic tumours, notably from medullary carcinoma.
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Affiliation(s)
- Alessandro Vanoli
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy,
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21
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Wu QY, Wan XY, Xie X, Lu BJ. Endometrial hepatoid adenocarcinoma: a rare cause of elevated serum α-fetoprotein. J Obstet Gynaecol Res 2015; 40:873-7. [PMID: 24738133 DOI: 10.1111/jog.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hepatoid adenocarcinoma is a rare and unusual tumor in the female genital tract. Hepatoid adenocarcinoma resembles hepatocellular carcinoma morphologically but develops in extrahepatic organs, and usually demonstrates foci of adenocarcinoma of the primary organ. Tumor cells often stain positive for anti-α-fetoprotein antibody, and may be associated with elevated serum α-fetoprotein, which may be useful as a tumor marker to guide treatment. There is little reliable information to guide clinical management of these unusual tumors and prognosis is poor despite multi-modal treatment. This report describes the diagnosis and treatment of this tumor in a postmenopausal woman.
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22
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Zhu X, Yong H, Zhang L, Huang Y, Zheng J, Liu C, Xiu D, Zhang P. Pure alpha-fetoprotein-producing neuroendocrine carcinoma of the pancreas: a case report. BMC Gastroenterol 2015; 15:16. [PMID: 25886790 PMCID: PMC4337100 DOI: 10.1186/s12876-015-0246-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background Alpha-fetoprotein (AFP)-producing pancreatic neuroendocrine tumors (pNETs) are rare, and the few reported cases usually coexisted with other malignant components such as adenocarcinoma or hepatoid carcinoma. We present here the first case of pure AFP-producing pNET. Case presentation A 56-year-old male patient underwent resection of the pancreatic tail and body because of elevated serum AFP levels and pancreatic mass. Microscopy showed that the tumor tissue consisted of large and small solid nests of polygonal cells. The tumor cells were positive for chromogranin A, synaptophysin, CD99, cytokeratin 19, pan-cytokeratin and β-catenin, and also showed diffuse immunoreactivity for AFP and human chorionic gonadotrophin. The mitotic rate was nearly 30 per 10 high-power fields and the Ki-67 index was nearly 25%. The histopathologic findings supported the diagnosis of an AFP-producing pNET. Other malignant components were not found. Serum AFP levels decreased to near-normal after operation and gradually increased to >1000 ng/ml at 5 months post-surgery. Recurrence and hepatic metastases were revealed by computed tomography. The patient died 21 months after surgery. Conclusion This was the first case of pure AFP-producing pNET to be reported in the English literature. Serum AFP levels may provide useful information for monitoring the therapeutic effectiveness, early recurrence or metastases.
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Affiliation(s)
- Xiang Zhu
- Department of Pathology, Peking University Third Hospital, Beijing, 100191, China. .,Department of Pathology, Peking University Health Science Center, Beijing, 100191, China.
| | - Huijuan Yong
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China.
| | - Li Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China.
| | - Yonghui Huang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China.
| | - Jie Zheng
- Department of Pathology, Peking University Third Hospital, Beijing, 100191, China. .,Department of Pathology, Peking University Health Science Center, Beijing, 100191, China.
| | - Cuiling Liu
- Department of Pathology, Peking University Third Hospital, Beijing, 100191, China. .,Department of Pathology, Peking University Health Science Center, Beijing, 100191, China.
| | - Dianrong Xiu
- Department of Surgery, Peking University Third Hospital, Beijing, 100191, China.
| | - Pan Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China.
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23
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Conversion of one cell type into another: implications for understanding organ development, pathogenesis of cancer and generating cells for therapy. Biochem Soc Trans 2015; 42:609-16. [PMID: 24849227 DOI: 10.1042/bst20140058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Metaplasia is the irreversible conversion of one differentiated cell or tissue type into another. Metaplasia usually occurs in tissues that undergo regeneration, and may, in a pathological context, predispose to an increased risk of disease. Studying the conditions leading to the development of metaplasia is therefore of significant clinical interest. In contrast, transdifferentiation (or cellular reprogramming) is a subset of metaplasia that describes the permanent conversion of one differentiated cell type into another, and generally occurs between cells that arise from neighbouring regions of the same germ layer. Transdifferentiation, although rare, has been shown to occur in Nature. New insights into the signalling pathways involved in normal tissue development may be obtained by investigating the cellular and molecular mechanisms in metaplasia and transdifferentiation, and additional identification of key molecular regulators in transdifferentiation and metaplasia could provide new targets for therapeutic treatment of diseases such as cancer, as well as generating cells for transplantation into patients with degenerative disorders. In the present review, we focus on the transdifferentiation of pancreatic cells into hepatocyte-like cells, the development of Barrett's metaplasia in the oesophagus, and the cellular and molecular mechanisms underlying both processes.
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24
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Soofi Y, Kanehira K, Abbas A, Aranez J, Bain A, Ylagan L. Pancreatic hepatoid carcinoma: a rare form of pancreatic neoplasm. Diagn Cytopathol 2014; 43:251-6. [PMID: 24965084 DOI: 10.1002/dc.23195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/05/2014] [Accepted: 06/11/2014] [Indexed: 12/20/2022]
Abstract
Primary pancreatic hepatoid carcinoma (PHC) is extremely rare, resembling hepatocellular carcinoma (HCC) in terms of morphology and immunohistochemical features. Hepatoid carcinoma can present in other organs, most noticeably in the stomach. PHC is present in two forms either a pure form like HCC or admixed with other histologic tumor components characteristic of the underlying primary site (endocrine tumors, ductal, or acinar adenocarcinomas). Here, we report a 69-year-old male patient with distal pancreatic mass incidentally found during a CT scan workup for a pulmonary nodule suspicious for metastatic prostate adenocarcinoma. We described the clinical, cytological, and histological finding and conducted a literature review.
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Affiliation(s)
- Yousef Soofi
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York
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25
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Takahashi N, Aoyama F, Hiyoshi M, Kataoka H, Sawaguchi A. Establishment and biological characterization of a novel cell line derived from hepatoid adenocarcinoma originated at the ampulla of Vater. Int J Oncol 2014; 44:1139-45. [PMID: 24481592 DOI: 10.3892/ijo.2014.2282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/03/2014] [Indexed: 12/12/2022] Open
Abstract
Hepatoid adenocarcinoma is a rare gastrointestinal tumor and mostly reported in the stomach. Effective chemotherapy has yet to be developed to improve poor prognosis. The present study was undertaken to establish a useful cell line derived from a hepatoid adenocarcinoma, possibly leading to a new therapeutic strategy. The new human cell line VAT-39 was established from a metastatic lymph node of a 69-year-old Japanese male patient with hepatoid adenocarcinoma of the ampulla of Vater. The primary tumor and metastatic lymph node were composed of hepatoid adenocarcinoma cells exhibiting immunohistochemical reactivity for alpha-fetoprotein (AFP) and glypican-3 (GPC3). In the metastatic lymph node, Periodic acid-Schiff (PAS) staining clarified diffuse deposition of glycogen in the cytoplasm, indicating analogous characteristics to the primary hepatoid adenocarcinoma. Moreover, VAT-39 cells produced high levels of AFP in the cultured medium, and reverse-transcriptase polymerase chain reaction (RT-PCR) verified increased expression of GPC3 mRNA in this cell line. Further, we evaluated the sensitivity to major chemotherapeutic drugs against the bile duct cancer. Neither 5-fluorouracil nor gemcitabine showed particular sensitivity to this cell line. The tumorigenicity of the cultured cells was confirmed in athymic nude mice and the histological features of the explanted tumor were similar to the VAT-39 cell line. The present VAT-39 is the first hepatoid adenocarcinoma cell line that originates from the ampulla of Vater and it will be applicable for basic biological studies searching for new strategies of molecular targeted chemotherapy to this disease.
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Affiliation(s)
- Nobuyasu Takahashi
- Department of Anatomy, Ultrastructural Cell Biology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Fumiyo Aoyama
- Department of Anatomy, Ultrastructural Cell Biology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Masahide Hiyoshi
- Department of Surgical Oncology and Regulation of Organ Function, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Hiroaki Kataoka
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Akira Sawaguchi
- Department of Anatomy, Ultrastructural Cell Biology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
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26
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Steen S, Wolin E, Geller SA, Colquhoun S. Primary hepatocellular carcinoma ("hepatoid" carcinoma) of the pancreas: a case report and review of the literature. Clin Case Rep 2013; 1:66-71. [PMID: 25356215 PMCID: PMC4184752 DOI: 10.1002/ccr3.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 09/19/2013] [Accepted: 10/10/2013] [Indexed: 12/13/2022] Open
Abstract
Key Clinical Message We present a case of hepatocellular carcinoma located within the pancreas. These tumors occur in the body and tail of the pancreas, with a male predominance, and at a younger age. Tumors with pure hepatocellular histopathology have better survival and recurrence rates and should be offered surgical therapy if possible.
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Affiliation(s)
- Shawn Steen
- Department of Surgical Oncology, John Wayne Cancer Institute Santa Monica, California
| | - Edward Wolin
- Department of Medical Oncology, Cedars Sinai Medical Center Beverly Hills, California
| | - Stephen A Geller
- Department of Pathology, Cedars Sinai Medical Center Beverly Hills, California
| | - Steven Colquhoun
- Department of Surgery, Cedars Sinai Medical Center Beverly Hills, California
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27
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Chen YY, Hsu WH, Hu HM, Wu DC, Lin WY. A case of alpha-fetoprotein-producing esophageal adenocarcinoma. Kaohsiung J Med Sci 2013; 29:106-10. [PMID: 23347813 DOI: 10.1016/j.kjms.2012.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/10/2012] [Indexed: 11/29/2022] Open
Abstract
Alpha-fetoprotein is a well-known tumor marker in the screening and follow-up of hepatocellular carcinoma. In Taiwanese society, a high prevalence of hepatitis and hepatoma and elevation of alpha-fetoprotein associated with liver function impairment usually suggested clinics undertake further examination for liver or genital tumor. We report the case of 45-year-old man who was found to have an alpha-fetoprotein-producing esophageal adenocarcinoma with an initial presentation of liver function impairment and rapid elevation of alpha-fetoprotein. Esophageal cancer was diagnosed via endoscope and a biopsy proved the presence of adenocarcinoma. A small endoscopic biopsy specimen failed to identify the alpha-fetoprotein positive tumor cell. Esophagectomy was performed and histopathological study of surgical specimen revealed grade II adenocarcinoma with regional metastatic lymphadenopathy. Immunohistochemical study was focal positive for alpha-fetoprotein. Serum alpha-fetoprotein declined transiently after esophagectomy and fluctuation of alpha-fetoprotein level was noted during the treatment with adjuvant chemotherapy. Finally, 19 months after the operation, the patient died due to multiple organ metastases with multiple organ failure. Thus, a small specimen for upper endoscopy may not be sufficient in the presence of alpha-fetoprotein-producing adenocarcinoma. Monitoring of serum alpha-fetoprotein may be useful in the evaluation and follow-up of esophageal alpha-fetoprotein-producing adenocarcinoma.
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Affiliation(s)
- Yi-Yu Chen
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Grüner BM, Hahne H, Mazur PK, Trajkovic-Arsic M, Maier S, Esposito I, Kalideris E, Michalski CW, Kleeff J, Rauser S, Schmid RM, Küster B, Walch A, Siveke JT. MALDI imaging mass spectrometry for in situ proteomic analysis of preneoplastic lesions in pancreatic cancer. PLoS One 2012; 7:e39424. [PMID: 22761793 PMCID: PMC3383687 DOI: 10.1371/journal.pone.0039424] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 05/20/2012] [Indexed: 01/07/2023] Open
Abstract
The identification of new biomarkers for preneoplastic pancreatic lesions (PanINs, IPMNs) and early pancreatic ductal adenocarcinoma (PDAC) is crucial due to the diseases high mortality rate upon late detection. To address this task we used the novel technique of matrix-assisted laser desorption/ionization (MALDI) imaging mass spectrometry (IMS) on genetically engineered mouse models (GEM) of pancreatic cancer. Various GEM were analyzed with MALDI IMS to investigate the peptide/protein-expression pattern of precursor lesions in comparison to normal pancreas and PDAC with cellular resolution. Statistical analysis revealed several discriminative m/z-species between normal and diseased tissue. Intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN) could be distinguished from normal pancreatic tissue and PDAC by 26 significant m/z-species. Among these m/z-species, we identified Albumin and Thymosin-beta 4 by liquid chromatography and tandem mass spectrometry (LC-MS/MS), which were further validated by immunohistochemistry, western blot, quantitative RT-PCR and ELISA in both murine and human tissue. Thymosin-beta 4 was found significantly increased in sera of mice with PanIN lesions. Upregulated PanIN expression of Albumin was accompanied by increased expression of liver-restricted genes suggesting a hepatic transdifferentiation program of preneoplastic cells. In conclusion we show that GEM of endogenous PDAC are a suitable model system for MALDI-IMS and subsequent LC-MS/MS analysis, allowing in situ analysis of small precursor lesions and identification of differentially expressed peptides and proteins.
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Affiliation(s)
- Barbara M. Grüner
- II. Medizinische Klinik, Technische Universität München, Munich, Germany
| | - Hannes Hahne
- Chair of Proteomics and Bioanalytics, Center of Life and Food Sciences, Technische Universität München, Munich, Germany
| | - Pawel K. Mazur
- II. Medizinische Klinik, Technische Universität München, Munich, Germany
| | | | - Stefan Maier
- Chair of Proteomics and Bioanalytics, Center of Life and Food Sciences, Technische Universität München, Munich, Germany
- Institute of Pathology, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany
| | - Irene Esposito
- Institute of Pathology, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Evdokia Kalideris
- II. Medizinische Klinik, Technische Universität München, Munich, Germany
| | | | - Jörg Kleeff
- Department of Surgery, Technische Universität München, Munich, Germany
| | - Sandra Rauser
- Institute of Pathology, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany
| | - Roland M. Schmid
- II. Medizinische Klinik, Technische Universität München, Munich, Germany
| | - Bernhard Küster
- Chair of Proteomics and Bioanalytics, Center of Life and Food Sciences, Technische Universität München, Munich, Germany
- Center for Integrated Protein Science Munich, Munich, Germany
| | - Axel Walch
- Institute of Pathology, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany
| | - Jens T. Siveke
- II. Medizinische Klinik, Technische Universität München, Munich, Germany
- * E-mail:
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A rare case of metastatic pancreatic hepatoid carcinoma treated with sorafenib. J Gastrointest Cancer 2012; 43:97-102. [PMID: 21365478 DOI: 10.1007/s12029-011-9264-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatoid carcinoma (HC) is a rare histopathological tumor type with prominent features of hepatoid differentiation, and while most of the reported cases are of gastric origin, ten cases of pancreatic HC have been reported to date. The majority of HC cases are metastatic at presentation, mainly to the liver, lymph nodes, and lungs. They are aggressive, invading, and proliferating in the venous and lymphatic systems, with a behavior similar to that of hepatocellular carcinoma. Diagnosis is challenging: alpha-Fetoprotein, the most useful marker, is not always positive. METHODS We present the first case of metastatic pancreatic HC treated with sorafenib, an oral multikinase inhibitor approved for advanced hepatocellular carcinoma that has antiangiogenic, pro-apoptotic, and raf-kinase inhibitory properties. RESULTS The patient, a 37-year-old male, was diagnosed with hepatoid carcinoma of the pancreas that had metastasized to liver, lungs, and lymph nodes. The cytokeratin (CK) profile was useful for the diagnosis: Both the hepatoid and adenocarcinoma components of the tumors were CK18+, CK19+, and CK20+/-, whereas normal and neoplastic hepatocytes are CK18+, CK19-, and CK20-. Amylase, lipase, and liver enzyme levels were elevated, but bilirubin was normal. Treatment with sorafenib resulted in more than 7 months of progression-free survival. Therapy was discontinued after 8 months when his bilirubin level increased dramatically. Signs of liver failure resolved temporarily with insertion of a biliary stent, but his condition deteriorated and he died 3 months later, 1 year after diagnosis. CONCLUSION In the absence of evidence-based experience with this rare and aggressive tumor and given its similarities with hepatocellular carcinoma, sorafenib should be considered as a possible treatment.
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Papatsimpas G, Kamposioras K, Goula K, Papaparaskeva K, Loukides S, Kotoulas C, Kelekis N, Xiros N, Pectasides D, Koumarianou A. Hepatoid pancoast tumor. A case report and review of the literature. Lung Cancer 2012; 77:239-45. [PMID: 22677427 DOI: 10.1016/j.lungcan.2012.05.102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/09/2012] [Accepted: 05/13/2012] [Indexed: 12/21/2022]
Abstract
A 48-year-old male patient presented with a Pancoast tumor of the right lung and a serum alpha-fetoprotein (αFP) at 39,000 ng/ml. Alpha-fetoprotein is a tumor marker found elevated in patients with hepatocellular carcinoma (HCC), germ cell or stromal tumors of the ovary and nonseminomatous testicular cancer. Occasionally, this tumor marker may rise in non-neoplastic conditions such as cirrhosis and hepatitis and only exceptionally in rare cancers with hepatoid differentiation. We present our case report and review the English literature for αFP-producing lung carcinomas. To the best of our knowledge this is the first report in the literature of an αFP producing Pancoast tumor.
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Affiliation(s)
- Georgios Papatsimpas
- Second Department of Internal Medicine Propaedeutic, Medical Oncology Unit, Attikon University Hospital, Athens, Greece
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Kai K, Nakamura J, Ide T, Masuda M, Kitahara K, Miyoshi A, Noshiro H, Tokunaga O. Hepatoid carcinoma of the pancreas penetrating into the gastric cavity: a case report and literature review. Pathol Int 2012; 62:485-90. [PMID: 22726068 DOI: 10.1111/j.1440-1827.2012.02814.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 79-year-old Japanese woman was admitted to our hospital for treatment of a pancreatic tumor measuring approximately 7 × 5 cm. The tumor had invaded the left adrenal gland and gastric wall and had penetrated into the gastric cavity. Surgical resection was performed. The tumor was composed of a brown to whitish solid area and a zone of hemorrhage, necrosis, and cystic degeneration resembling the gross features of solid pseudopapillary tumor (SPT). Histologically, the tumor showed a heterogeneous growth pattern with a combination of seat-like, trabecular, papillary and hemorrhagic-necrotic areas in various proportions. The differential diagnoses first considered were acinar cell carcinoma, neuroendocrine carcinoma and SPT with malignant transformation. Immunohistochemistry showed tumor cells were negative for pancreatic exocrine enzymes and endocrine markers. Tumor cells diffusely expressed cytokeratin 19, alpha-fetoprotein, carcinoembryonic antigen and glypican-3, but lacked vimentin or β-catenin expression. Small proportions of tumor cells expressed hepatocyte paraffin-1. Although typical morphological features of well-differentiated hepatocellular carcinoma (HCC) were not distinctly apparent, the tumor morphology partly resembled poorly differentiated HCC. Given these findings and considerations, the tumor was finally diagnosed as poorly differentiated hepatoid carcinoma of the pancreas.
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Affiliation(s)
- Keita Kai
- Department of Pathology and Microbiology, Saga University Faculty of Medicine, Saga, Japan.
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33
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Kelly PJ, Spence R, Dasari BV, Burt AD, Taylor M, Loughrey MB. Primary hepatocellular carcinoma of the pancreas: a case report and review of the heterogeneous group of pancreatic hepatoid carcinomas. Histopathology 2012; 60:1012-5. [PMID: 22320681 DOI: 10.1111/j.1365-2559.2011.04129.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Chung WS, Park MS, Kim DW, Kim KW. Case report. Acinar cell carcinoma with fatty change arising from the pancreas. Br J Radiol 2012; 84:e226-8. [PMID: 22101587 DOI: 10.1259/bjr/15914752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Acinar cell carcinoma of the pancreas is a rare malignant tumour developing from acinar cells, accounting for approximately 1% of pancreatic exocrine tumours. We experienced a case of an acinar cell carcinoma with fatty change. To the best of our knowledge, this is the first case report of an acinar cell carcinoma with fatty change in the clinical literature.
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Affiliation(s)
- W-S Chung
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Severance Hospital, Seodaemunku, Shinchon-dong 134, Seoul 120-752, Korea
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Zener R, Gologan O, Sands N, Zeitouni AG. Hepatoid adenocarcinoma of the anterior skull base: a case report. SKULL BASE REPORTS 2011; 1:95-8. [PMID: 23984209 PMCID: PMC3743597 DOI: 10.1055/s-0031-1276723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/21/2010] [Indexed: 12/03/2022]
Abstract
We report the first case of hepatoid adenocarcinoma of the skull base, as well as the first reported case in the head and neck region. Hepatoid adenocarcinoma is a rare, aggressive, extrahepatic malignancy with a distinct morphological similarity to hepatocellular carcinoma, in the absence of primary hepatic disease. A 45-year-old man presented with sinus headaches and retro-orbital pain and was found to have a nasopharyngeal mass on endoscopy and a large, destructive sinonasal mass extending intracranially on imaging. Histo- and cytopathological features were similar to hepatocellular carcinoma, and the cells were immunoreactive for α-fetoprotein, epithelial membrane antigen, periodic acid-Schiff, cytokeratin (CK)8/18, CK19, and S100.
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Affiliation(s)
- Rebecca Zener
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
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Hyaline globules in neuroendocrine and solid-pseudopapillary neoplasms of the pancreas: a clue to the diagnosis. Am J Surg Pathol 2011; 35:981-8. [PMID: 21677537 DOI: 10.1097/pas.0b013e31821a9a14] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Distinguishing between solid-pseudopapillary neoplasms (SPNs) and pancreatic neuroendocrine tumors (PanNETs) may pose a diagnostic dilemma. Both can demonstrate solid growth patterns, and both can be immunoreactive with neuroendocrine markers such as synaptophysin and CD56. One well-established feature of SPNs is the presence of hyaline globules, which in contrast has only rarely been reported in PanNETs. Clinicopathologic features of 361 cases originally classified as PanNETs were examined. Of these, 24 tumors (6.6%) had hyaline globules, raising the possibility of SPN. Immunohistochemistry for β-catenin was performed on these 24 neoplasms, and showed nuclear labeling in 6 cases. These 6 cases, which also demonstrated cytoplasmic CD10 staining, were reclassified as SPNs. The remaining 18 cases maintained their original diagnosis as PanNETs, and the hyaline globules in these cases were periodic acid-Schiff (PAS) positive, diastase resistant, and immunoreactive with α-1-antitrypsin. All 24 cases were histologically re-evaluated, and the pattern of invasion, presence of clear cells, and nuclear grooves were found to be helpful in distinguishing SPNs from PanNETs. We conclude that the presence of hyaline globules should raise SPNs in the differential diagnosis of a solid cellular neoplasm of the pancreas. However, this should not be used as the sole criterion in the diagnosis of SPNs, as hyaline globules may also be seen in 5% of PanNETs. Immunohistochemical and histologic features supporting the diagnosis of SPNs over PanNETs include CD10 and nuclear β-catenin labeling, an insidious pattern of invasion, clear cells, and nuclear grooves.
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Bortesi L, Pesci A, Bogina G, Castelli P, Zamboni G. Ductal Adenocarcinoma of the Pancreas. Surg Pathol Clin 2011; 4:487-521. [PMID: 26837485 DOI: 10.1016/j.path.2011.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) and its variants comprise between 80% and 90% of all tumors of the exocrine pancreas. Because of its silent course, late clinical manifestation, and rapid growth, it is considered a silent killer. Only 10% to 15% of cases are resectable and the 5-year survival rate remains lower than 5%. The differential diagnosis between PDAC and chronic pancreatitis is a challenge for pathologists. This article provides a guide for pathologic evaluation of PDAC specimens with the macroscopic and microscopic features of common PDAC and its variants and discusses the differential diagnosis and morphologic and immunophenotypical prognostic parameters.
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Affiliation(s)
- Laura Bortesi
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Via don Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Anna Pesci
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Via don Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Giuseppe Bogina
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Via don Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Paola Castelli
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Via don Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Giuseppe Zamboni
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Via don Sempreboni 5, 37024 Negrar, Verona, Italy; Department of Pathology, University of Verona, Ple. Scuro 10, 37134 Verona, Italy.
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Abstract
Hepatocytes maintained in culture provide an attractive model system for the study of liver function. Furthermore, hepatocyte transplantation offers an alternative cellular therapy to orthotopic liver transplantation for the treatment of hepatic failure and hereditary liver disease. To overcome the problem of organ shortage, additional source of hepatocytes must be found. Here, we present a strategy and protocol to transdifferentiate (or convert) developmentally related pancreatic cells into hepatocytes based on the addition of the synthetic glucocorticoid dexamethasone.
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Al-Adsani A, Burke ZD, Eberhard D, Lawrence KL, Shen CN, Rustgi AK, Sakaue H, Farrant JM, Tosh D. Dexamethasone treatment induces the reprogramming of pancreatic acinar cells to hepatocytes and ductal cells. PLoS One 2010; 5:e13650. [PMID: 21048969 PMCID: PMC2965100 DOI: 10.1371/journal.pone.0013650] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 09/19/2010] [Indexed: 01/18/2023] Open
Abstract
Background The pancreatic exocrine cell line AR42J-B13 can be reprogrammed to hepatocytes following treatment with dexamethasone. The question arises whether dexamethasone also has the capacity to induce ductal cells as well as hepatocytes. Methodology/Principal Findings AR42J-B13 cells were treated with and without dexamethasone and analyzed for the expression of pancreatic exocrine, hepatocyte and ductal markers. Addition of dexamethasone inhibited pancreatic amylase expression, induced expression of the hepatocyte marker transferrin as well as markers typical of ductal cells: cytokeratin 7 and 19 and the lectin peanut agglutinin. However, the number of ductal cells was low compared to hepatocytes. The proportion of ductal cells was enhanced by culture with dexamethasone and epidermal growth factor (EGF). We established several features of the mechanism underlying the transdifferentiation of pancreatic exocrine cells to ductal cells. Using a CK19 promoter reporter, we show that a proportion of the ductal cells arise from differentiated pancreatic exocrine-like cells. We also examined whether C/EBPβ (a transcription factor important in the conversion of pancreatic cells to hepatocytes) could alter the conversion from acinar cells to a ductal phenotype. Overexpression of an activated form of C/EBPβ in dexamethasone/EGF-treated cells provoked the expression of hepatocyte markers and inhibited the expression of ductal markers. Conversely, ectopic expression of a dominant-negative form of C/EBPβ, liver inhibitory protein, inhibited hepatocyte formation in dexamethasone-treated cultures and enhanced the ductal phenotype. Conclusions/Significance These results indicate that hepatocytes and ductal cells may be induced from pancreatic exocrine AR42J-B13 cells following treatment with dexamethasone. The conversion from pancreatic to hepatocyte or ductal cells is dependent upon the expression of C/EBPβ.
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Affiliation(s)
- Amani Al-Adsani
- Department of Biology and Biochemistry, Centre for Regenerative Medicine, University of Bath, Bath, United Kingdom
| | - Zoë D. Burke
- Department of Biology and Biochemistry, Centre for Regenerative Medicine, University of Bath, Bath, United Kingdom
| | - Daniel Eberhard
- Department of Biology and Biochemistry, Centre for Regenerative Medicine, University of Bath, Bath, United Kingdom
| | - Katherine L. Lawrence
- Department of Biology and Biochemistry, Centre for Regenerative Medicine, University of Bath, Bath, United Kingdom
| | - Chia-Ning Shen
- Stem Cell Program, Genomics Research Center, Academia Sinica, Taipei, Taiwan, Republic of China
| | - Anil K. Rustgi
- Department of Medicine and Genetics, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Hiroshi Sakaue
- Department of Nutrition and Metabolism, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - J. Mark Farrant
- Department of Gastroenterology, Royal United Hospital, Bath, United Kingdom
| | - David Tosh
- Department of Biology and Biochemistry, Centre for Regenerative Medicine, University of Bath, Bath, United Kingdom
- * E-mail:
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Wu SY, Hsieh CC, Wu RR, Susanto J, Liu TT, Shen CR, Chen Y, Su CC, Chang FP, Chang HM, Tosh D, Shen CN. Differentiation of pancreatic acinar cells to hepatocytes requires an intermediate cell type. Gastroenterology 2010; 138:2519-30. [PMID: 20178796 DOI: 10.1053/j.gastro.2010.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 01/06/2010] [Accepted: 02/09/2010] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The appearance of hepatic foci in pancreas has been well-documented in animal experiments and in patients with pancreatic cancer. We previously demonstrated that transdifferentiation of pancreatic exocrine cells to hepatocytes required members of the CCAAT enhancer binding protein family. Although the molecular basis of hepatic transdifferentiation is understood, the early cellular events remain to be defined. METHODS Dexamethasone and oncostatin M were used to induce transdifferentiation of primary cultures of mouse acinar cells and exocrine cell lines into hepatocytes. Fluorescent-activated cell sorting was used to identify intermediate cell types and side-population characteristics. Cre-loxP-based lineage tracing was used to investigate whether acinar cells contribute directly to hepatocytes via intermediates that express adenosine triphosphate-binding cassette subfamily G member 2 (ABCG2). RESULTS Lineage tracing studies showed that hepatocytes were derived directly from pancreatic cells via ABCG2-expressing intermediates. Exposure of cells to insulin increased Akt phosphorylation, ABCG2 expression, and hepatic transdifferentiation. Inhibition of the phosphoinositide 3-kinase pathway, through addition of LY294002 or overexpression of a dominant-negative form of Akt, was sufficient to prevent transdifferentiation. When ABCG2-expressing cells were incubated with glucagon-like-peptide 1 or epidermal growth factor, the intermediate cells could differentiate into insulin-producing beta-like cells. CONCLUSIONS The phosphoinositide 3-kinase pathway is important in the transdifferentiation of acinar cells to hepatocytes and those hepatocytes arise from acinar cells via ABCG2-expressing intermediates. Furthermore, ABCG2-expressing cells are multipotent and able to differentiate into hepatocytes and insulin-producing beta cells.
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Affiliation(s)
- Sung-Yu Wu
- Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
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Tajiri T, Inagaki T, Ohike N, Omatsu M, Kasugai H, Kunimura T, Shiokawa A, Mitsuya T, Morohoshi T. Intraductal oncocytic papillary carcinoma of the pancreas showing numerous hyaline globules in the lumen. Pathol Int 2010; 60:48-54. [PMID: 20055952 DOI: 10.1111/j.1440-1827.2009.02474.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two cases of intraductal oncocytic papillary carcinoma (IOPC) treated surgically were analyzed on light microscopy and immunohistochemistry: that of a 61-year-old man and that of a 55-year-old man. There were no clinical symptoms in either case. Pancreatic abnormalities were discovered incidentally on CT. Various clinical examinations were carried out, and the preoperative diagnosis was intraductal papillary mucinous carcinoma (IPMC) in both cases. Surgery was performed. Macroscopic observation of tissue cross-sections indicated multilocular cystic mass containing polypoid lesions encapsulated by the dilated pancreatic duct. Histologically, the cyst walls were lined by columnar epithelial cells with complex papillary projections associated with oxyphilic cytoplasm, and they were strongly immunoreactive with anti-mitochondrial antibody in the cytoplasm. Electron microscopy showed numerous mitochondria in the cytoplasm. IOPC was diagnosed. Interestingly, amorphous hyaline globules were produced from the oxyphilic cells, which exhibited a bud-like appearance. The hyaline globules were not positive for mucin staining. No case of IPMC with hyaline globules has been reported to date. The production of hyaline globules may be related to oncocytic differentiation. It is suggested that hyaline globules should be regarded as a characteristic of IOPC.
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Affiliation(s)
- Takuma Tajiri
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan.
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Jung JY, Kim YJ, Kim HM, Kim HJ, Park SW, Song SY, Chung JB, Kang CM, Pyo JY, Yang WI, Bang S. Hepatoid carcinoma of the pancreas combined with neuroendocrine carcinoma. Gut Liver 2010; 4:98-102. [PMID: 20479919 DOI: 10.5009/gnl.2010.4.1.98] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 05/29/2009] [Indexed: 12/26/2022] Open
Abstract
Hepatoid carcinoma is a primary extrahepatic carcinoma whose morphology, immunohistochemistry, and behavior are similar to those of hepatocellular carcinoma. The most common sites of extrahepatic carcinoma are the stomach and ovary, but nine cases of hepatocellular differentiation of the pancreas have been reported in the literature. We report another case of hepatoid carcinoma of the pancreas that was associated with the development of a pancreatic endocrine carcinoma in a 46-year-old man. Serum alpha-fetoprotein (AFP) was elevated to 262.49 IU/mL and radiological examinations revealed a mass measuring 7.5 cm in diameter in the head of the pancreas. He underwent a conventional Whipple operation, and light microscopy showed adenocarcinoma that was immunopositive for AFP, hepatocyte antigen, cytokeratin, chromogranin, synaptophysin, and alpha-1 antichymotrypsin. Although hepatoid differentiation was not shown unequivocally histologically, other immunohistochemistry findings supported the diagnosis of hepatoid carcinoma combined with neuroendocrine carcinoma. The patient was healthy and had no evidence of recurrence at 4 months after the surgery. This report describes why hepatoid carcinoma should be considered as a differential diagnosis of a pancreatic mass, especially when serum AFP is elevated.
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Affiliation(s)
- Ji Ye Jung
- Division of Gastroenterology, Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Hepatoid carcinoma of the skin: spontaneous rat skin hepatoid carcinoma with eosinophilic globules and crystals immunoreactive to alpha-1-antitrypsin. Med Mol Morphol 2009; 42:118-22. [PMID: 19536619 DOI: 10.1007/s00795-009-0440-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 02/10/2009] [Indexed: 12/20/2022]
Abstract
We present a case of hepatoid carcinoma of the abdominal skin in a male Wistar rat. Histopathologically, this carcinoma resembled human hepatocellular carcinoma with respect to trabecular-sinusoidal structures. Carcinoma tissues contain numerous eosinophilic globules and crystals, and in this case, we found the characteristic eosinophilic globules in the hepatoid carcinoma cells and the crystals in the extracellular portions. Vivid carcinoma cells full of eosinophilic globules were present near the necrotic areas in tumor tissue, wherein quadrate crystals unstained with eosin were observed. PAS staining after diastase digestion revealed that the globules were PAS positive and diastase resistant. In addition, we found that the hepatoid carcinoma cells were immunoreactive for alpha-1-antitrypsin (anti-A1AT) antibody with the globules and crystals staining peripherally, and a central unstained region. Ultrastructural study of intracytoplasmic globules and extracellular crystals revealed that the fringe of each globule and crystal had no limiting membrane and showed the same level of electron density. These findings suggest that the characteristic crystals in this tumor may have originated from the globules that were emitted from the carcinoma cells after their death as a result of saturation with intracytoplasmic globules.
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Sakamoto K, Monobe Y, Kouno M, Moriya T, Sasano H. Hepatoid adenocarcinoma of the gallbladder: Case report and review of the literature. Pathol Int 2008; 54:52-6. [PMID: 14674996 DOI: 10.1111/j.1440-1827.2004.01578.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A rare case of hepatoid adenocarcinoma (HAC) of the gallbladder occurred in a 72-year-old man who presented with abdominal pain and was admitted to hospital. Ultrasonography and computed tomography revealed a mass in the gallbladder, multiple nodules in the liver and enlargement of the lymph nodes. He was diagnosed as having a gallbladder carcinoma with multiple liver and lymph node metastases. Cholecystectomy and partial hepatectomy was performed. Histologically, most of the mass in the gallbladder was composed of cells with eosinophilic cyto-plasm arranged in a trabecular pattern, which resembled hepatocellular carcinoma, but there was a component of well-differentiated adenocarcinoma in the mucosa. Immunohistochemically these hepatoid tumor cells were positive for Hepatocyte (Hepatocyte Paraffin 1: Hep Par1), which is considered highly sensitive and highly specific for hepatocyte differentiation. Based on these findings, this case was diagnosed as hepatoid adenocarcinoma of the gallbladder, which is generally a vary rare neoplasm in the literature, but should be included in the differential diagnosis of a mass in the gallbladder.
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Kubota K, Kita J, Rokkaku K, Iwasaki Y, Sawada T, Imura J, Fujimori T. Ectopic hepatocellular carcinoma arising from pancreas: A case report and review of the literature. World J Gastroenterol 2007; 13:4270-3. [PMID: 17696261 PMCID: PMC4250631 DOI: 10.3748/wjg.v13.i31.4270] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.
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Affiliation(s)
- Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo University Hospital, 880 Kitakobayashi, Mibu, Tochigi, Japan.
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47
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Abstract
Stem cells are undifferentiated cells that can self-renew and generate specialized (functional) cell types. The remarkable ability of stem cells to differentiate towards functional cells makes them suitable modalities in cellular therapy (which means treating diseases with the body's own cells). Potential targets for cellular therapy include diabetes and liver failure. However, in order for stem cells to be clinically useful, we must learn to identify them and to regulate their differentiation. We will use the intestine as a classical example of a stem cell compartment, and then examine the evidence for the existence of adult stem cells in two endodermally derived organs: pancreas and liver. We will review the characteristics of the putative stem cells in these tissues and the transcription factors controlling their differentiation towards functional cell types.
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Affiliation(s)
- Zoë D. Burke
- *Centre for Regenerative Medicine, Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath BA2 7AY, U.K
| | - Shifaan Thowfeequ
- *Centre for Regenerative Medicine, Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath BA2 7AY, U.K
| | - Macarena Peran
- †Departamento de Neurociencias y Ciencias de la Salud, Universidad de Almería, Carretera de Sacramento s/n, Almería 04120, Spain
| | - David Tosh
- *Centre for Regenerative Medicine, Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath BA2 7AY, U.K
- To whom correspondence should be addressed (email )
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48
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Orditura M, Lieto E, Ferraraccio F, De Cataldis G, Troiani T, Castellano P, Catalano G, Ciardiello F, Galizia G, De Vita F. Hepatoid carcinoma colliding with a liposarcoma of the left colon serosa presenting as an abdominal mass. World J Surg Oncol 2007; 5:42. [PMID: 17448253 PMCID: PMC1866233 DOI: 10.1186/1477-7819-5-42] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 04/22/2007] [Indexed: 11/10/2022] Open
Abstract
Background Hepatoid adenocarcinoma (HAC) is a peculiar type of extrahepatic adenocarcinoma generally characterized by adenocarcinomatous and hepatocellular carcinoma (HCC)-like foci. Stomach is the most frequent site where hepatoid adenocarcinoma occurs, although it has been described in many other organs. On the other side, liposarcoma is a rare, malignant tumor that develops from fat cells. Case presentation We describe here a case of hepatoid carcinoma in collision with a liposarcoma of the left colon serosa in a 71-year-old man. It presented as an abdominal mass involving several organs, falsely mimicking metastatic colonic adenocarcinoma. Recognition of this entity was evident on microscopic evaluation following surgery. The patient had an objective response following liposomal antracycline chemotherapy, with a 3-year overall survival. Conclusion To our knowledge, this is the first case of a hepatoid tumor colliding with a liposarcoma of the left colon serosa reported to date.
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Affiliation(s)
- Michele Orditura
- Cattedra di Oncologia Medica, Seconda Università degli Studi di Napoli °Ospedale "Da Procida", Salerno, Naples, Italy
- Department of Clinical and Experimental Medicine, Second University of Naples School of Medicine, Naples, Italy c/o II Policlinico Via S. Pansini, 5 80131, Naples, Italy
| | - Eva Lieto
- Cattedra di Chirurgia Generale ed Epatobiliare, Seconda Università degli Studi di Napoli Ospedale "Da Procida", Salerno, Naples, Italy
| | - Francesca Ferraraccio
- Cattedra di Anatomia e Istologia Patologica – Seconda Università degli Studi di Napoli °Ospedale "Da Procida", Salerno, Naples, Italy
| | - Giuseppe De Cataldis
- Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi – A. Lanzara" Naples, Italy
| | - Teresa Troiani
- Cattedra di Oncologia Medica, Seconda Università degli Studi di Napoli °Ospedale "Da Procida", Salerno, Naples, Italy
| | - Paolo Castellano
- Cattedra di Chirurgia Generale ed Epatobiliare, Seconda Università degli Studi di Napoli Ospedale "Da Procida", Salerno, Naples, Italy
| | - Giuseppe Catalano
- Cattedra di Oncologia Medica, Seconda Università degli Studi di Napoli °Ospedale "Da Procida", Salerno, Naples, Italy
| | - Fortunato Ciardiello
- Cattedra di Oncologia Medica, Seconda Università degli Studi di Napoli °Ospedale "Da Procida", Salerno, Naples, Italy
| | - Gennaro Galizia
- Cattedra di Chirurgia Generale ed Epatobiliare, Seconda Università degli Studi di Napoli Ospedale "Da Procida", Salerno, Naples, Italy
| | - Ferdinando De Vita
- Cattedra di Oncologia Medica, Seconda Università degli Studi di Napoli °Ospedale "Da Procida", Salerno, Naples, Italy
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Hameed O, Xu H, Saddeghi S, Maluf H. Hepatoid carcinoma of the pancreas: a case report and literature review of a heterogeneous group of tumors. Am J Surg Pathol 2007; 31:146-52. [PMID: 17197931 DOI: 10.1097/01.pas.0000213370.79300.e1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatoid carcinomas are tumors that display, at least focally, cytologic and/or architectural features of hepatocellular carcinoma. They have been described in several organs, most notably in the stomach and ovary. We report a case of hepatoid carcinoma of the pancreas that developed in a 41-year-old woman in association with a pancreatic endocrine carcinoma. The fine needle aspiration material was characterized by the presence of monotonous, small-to-medium sized tumor cells with round nuclei and finely granular chromatin, intermixed with more atypical tumor cells displaying larger nuclei with coarse clumped chromatin, prominent nucleoli, and moderate amounts of foamy cytoplasm. The excised specimen displayed a poorly differentiated pancreatic endocrine carcinoma associated with well-defined islands of larger tumor cells growing in a perisinusoidal pattern which, based on their immunohistochemical profile and the demonstration of bile, proved to represent a hepatoid component. This case and prior examples in the literature suggest that hepatoid carcinomas of the pancreas appear to be a heterogeneous group of tumors (pure or associated with another histologic component) that are often associated with early liver metastasis and a short survival, although those arising as a component of endocrine tumors seem to fare slightly better. Hepatoid carcinoma of the pancreas should be included in the differential diagnosis of pancreatic tumors composed of large eosinophilic cells.
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Affiliation(s)
- Omar Hameed
- Lauren V. Ackerman Laboratory of Surgical Pathology and the Department of Pathology, Washington University School of Medicine, St Louis, MO, USA.
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Hruban RH, Fukushima N. Pancreatic adenocarcinoma: update on the surgical pathology of carcinomas of ductal origin and PanINs. Mod Pathol 2007; 20 Suppl 1:S61-70. [PMID: 17486053 DOI: 10.1038/modpathol.3800685] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pancreatic cancer is the fourth leading cause of cancer death in the US. Most pancreatic cancers are infiltrating ductal adenocarcinomas. The careful application of well-defined morphologic criteria can be used to differentiate between infiltrating ductal adenocarcinoma and reactive glands. While most pancreatic cancers are ductal adenocarcinomas, a number of histologically defined variants have been described. These are important to recognize because they have distinct clinical pathologic features. Pancreatic intraepithelial neoplasia (PanIN) is the presumed precursor lesion to infiltrating ductal adenocarcinoma, and PanIN lesions can mimic infiltrating cancer.
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Affiliation(s)
- Ralph H Hruban
- Departments of Pathology and Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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