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de Jesus VHF, Donadio MDS, de Brito ÂBC, Gentilli AC. A narrative review on rare types of pancreatic cancer: should they be treated as pancreatic ductal adenocarcinomas? Ther Adv Med Oncol 2024; 16:17588359241265213. [PMID: 39072242 PMCID: PMC11282540 DOI: 10.1177/17588359241265213] [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] [Received: 02/17/2024] [Accepted: 06/13/2024] [Indexed: 07/30/2024] Open
Abstract
Pancreatic cancer is one of the deadliest malignancies in humans and it is expected to play a bigger part in cancer burden in the years to come. Pancreatic ductal adenocarcinoma (PDAC) represents 85% of all primary pancreatic malignancies. Recently, much attention has been given to PDAC, with significant advances in the understanding of the mechanisms underpinning disease initiation and progression, along with noticeable improvements in overall survival in both localized and metastatic settings. However, given their rarity, rare histological subtypes of pancreatic cancer have been underappreciated and are frequently treated as PDAC, even though they might present non-overlapping molecular alterations and clinical behavior. While some of these rare histological subtypes are true variants of PDAC that should be treated likewise, others represent separate clinicopathological entities, warranting a different therapeutic approach. In this review, we highlight clinical, pathological, and molecular aspects of rare histological types of pancreatic cancer, along with the currently available data to guide treatment decisions.
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Affiliation(s)
- Victor Hugo Fonseca de Jesus
- Oncoclínicas, Department of Gastrointestinal Medical Oncology, Santos Dumont St. 182, 4 floor, Florianópolis, Santa Catarina 88015-020, Brazil
- Department of Medical Oncology, Centro de Pesquisas Oncológicas, Florianópolis, Santa Catarina, Brazil
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Correia AM, Ribeiro C, Videira F, Gigliano D, Cunha AL, Afonso LP, Peyroteo M, Canotilho R, Baía C, Sousa F, de Sousa JA. Not a neuroendocrine tumor: A case of hepatocellular carcinoma in ectopic liver tissue in the pancreas. Ann Hepatobiliary Pancreat Surg 2023; 27:102-106. [PMID: 36003000 PMCID: PMC9947366 DOI: 10.14701/ahbps.22-024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) accounts for most of the hepatic neoplasms and can also occur in ectopic liver tissue. We present a case of a 55-year-old male complaining of weight loss. The imaging studies reported a 2.9 cm nodule in the pancreatic body, with a neuroendocrine tumor diagnosis by cytology. A corpo-caudal pancreatectomy was performed. Pathology showed a well-differentiated HCC developed in ectopic liver tissue with free margins and no lymph node metastases. HCC presenting in ectopic liver tissue is rare. In this case, the preoperative study did not establish the diagnosis, warranting the need for suspicion of this neoplasm.
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Affiliation(s)
- Ana Margarida Correia
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal,Corresponding author: Ana Margarida Correia, MD Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Rua Dr. António Bernardino de Almeida, Porto 4200-072, Portugal Tel: +351-225-084-000, Fax: +351-225-084-001, E-mail: ORCID: https://orcid.org/0000-0003-0112-7401
| | - Cátia Ribeiro
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Flávio Videira
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Davide Gigliano
- Department of Anatomical Pathology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Ana Luísa Cunha
- Department of Anatomical Pathology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Luís Pedro Afonso
- Department of Anatomical Pathology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Mariana Peyroteo
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Rita Canotilho
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Catarina Baía
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Fernanda Sousa
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
| | - Joaquim Abreu de Sousa
- Department of Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
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Hundal J, Nagaraj A, Luke A, Vredenburgh J. A rare case of metastatic ectopic fibrolamellar hepatocellular carcinoma in a young healthy patient: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vining CC, Hsu PJ, Schuitevoerder D, Joseph NE, Hogg ME. Robotic Distal Pancreatectomy and Splenectomy for an Intrapancreatic Hepatocellular Carcinoma: A Case Report and Review of the Literature. J Pancreat Cancer 2020; 6:96-101. [PMID: 34095737 PMCID: PMC8175251 DOI: 10.1089/pancan.2020.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Liver parenchyma that resides outside of the normal hepatic confines is defined as accessory liver if in communication with the native biliary tree, or ectopic liver (EL) if it is not. EL can develop in a variety of tissues, including but not limited to the gallbladder, the hepatic ligaments, the pancreas, and retroperitoneum. EL has an increased propensity for malignant degeneration resulting in hepatocellular carcinoma (HCC). Presentation: A 67-year-old Korean male presented with epigastric discomfort and was found to have an elevation in his transaminases. Cross-sectional imaging demonstrated a 1.3 cm solid mass in the body of the pancreas with features concerning for either a pancreatic ductal adenocarcinoma or pancreatic neuroendocrine tumor. Subsequent endoscopic ultrasound and fine needle aspiration demonstrated cells of epithelial origin with hepatocellular differentiation. A robotic-assisted distal pancreatectomy and splenectomy was performed with final pathology demonstrating a well-differentiated HCC. Conclusions: EL with malignant degeneration resulting in HCC requires surgical excision. The majority of patients reported with EL resulting in HCC in the pancreas have had the tumors located in the body and tail. Therefore, definitive treatment requires distal pancreatectomy and splenectomy. Herein, we describe the presentation, workup, and definitive treatment of HCC arising in the pancreas.
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Affiliation(s)
- Charles C. Vining
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Phillip J. Hsu
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
- Medical Scientist Training Program, University of Chicago, Chicago, Illinois, USA
| | | | - Nora E. Joseph
- Department of Pathology and NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E. Hogg
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
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Zeng SX, Tan SW, Fong CJTH, Liang Q, Zhao BL, Liu K, Guo JX, Tao J. Hepatoid carcinoma of the pancreas: A case report and review of the literature. World J Clin Cases 2020; 8:1116-1128. [PMID: 32258082 PMCID: PMC7103969 DOI: 10.12998/wjcc.v8.i6.1116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/16/2020] [Accepted: 02/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatoid carcinoma (HC) is an extremely rare neoplasm that is morphologically similar to hepatocellular carcinoma. HC has been described in various organs; however, HC of the pancreas is extremely rare. To our knowledge, only 38 cases have been reported. We present a case of HC of the pancreas in a 36-year-old male patient.
CASE SUMMARY A 36-year-old cachexic man with no significant past medical history was transferred to our hospital with a history of painless jaundice, elevated blood glucose and significant weight loss. Lab tests showed elevated serum transaminases, bilirubin and alpha-fetoprotein levels. Magnetic resonance imaging of the upper abdomen showed a diffusely enlarged pancreas, appearing “sausage-shaped”. Magnetic resonance cholangiopancreatography showed upstream ductal dilation secondary to stricture of the main pancreatic duct and the common bile duct, which were not visible. Immunohistochemistry of biopsied tissue from a percutaneous pancreatic biopsy showed tumor cell positivity for HepPar1, polyclonal carcinoembryonic antigen and CK19, suggestive of HC of the pancreas. The characteristics of 39 patients with HC of the pancreas were reviewed.
CONCLUSION HC of the pancreas is more prevalent in males, and patients have a median age of 57 years. It is most commonly asymptomatic or presents as abdominal back pain, and the pancreatic tail is the most common location. At the time of diagnosis, liver metastasis is often present.
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Affiliation(s)
- Shao-Xiong Zeng
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Si-Wei Tan
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Christ-Jonathan Tsia Hin Fong
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Qiong Liang
- Department of Pathology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Bin-Liang Zhao
- Department of Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Ke Liu
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Jia-Xiang Guo
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Jin Tao
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
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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
INTRODUCTION Ectopic liver (EL) is a rare entity, which is reported to develop at various sites, such as the abdominal cavity, the retroperitoneal cavity, the pleural cavity, and the mediastinum. PATIENT CONCERNS A 27-year-old previously healthy Chinese man suffered from a discontinuous abdominal pain in the upper abdomen for 2 months. DIAGNOSIS The upper gastrointestinal endoscopy revealed there was a polypoid mucosal uplift on the distal region of the esophagus near the cardia. INTERVENTIONS Endoscopic polypectomy was performed. OUTCOMES Pathology examination showed the liver tissue. CONCLUSION EL should be excised as it may possibly lead to the development of a malignancy. Endoscopic resection was found to be safe and reliable in this case.
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Affiliation(s)
- Zi-Li Zhang
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Jin-Liang Wang
- Department of General Surgery, Xingtai Third Hospital, Xingtai, Hebei, People's Republic of China
| | - Chun-Li Guo
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Qi Li
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Lin Li
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Yi Pang
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Xiang-Chao Meng
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
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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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9
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Rare pancreatic masses: a pictorial review of radiological concepts. Clin Imaging 2018; 50:314-323. [DOI: 10.1016/j.clinimag.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/08/2018] [Accepted: 05/01/2018] [Indexed: 02/07/2023]
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Pure hepatocellular carcinoma originates from an ectopic liver nodule located in the pancreas. Contemp Oncol (Pozn) 2017; 21:311-314. [PMID: 29416439 PMCID: PMC5799705 DOI: 10.5114/wo.2017.72403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/22/2017] [Indexed: 12/15/2022] Open
Abstract
Ectopic liver (EL) is a rare congenital abnormality, which is localised most commonly in the wall of the gallbladder. Histoarchitectural abnormalities, which lead to impaired transfer of blood and bile, as well as well demarcation, are characteristic features of ectopic liver nodules. Both features may explain the discrepancies between hepatocellular carcinoma (HCC) cases originating from ectopic liver in comparison to HCC cases originating from orthotopic liver: the strong propensity of ectopic liver to the development of HCC. The latter feature may be linked to the better treatment prognosis in patients with HCC originating from ectopic liver tissue in comparison to those with HCC within orthotopic liver. In this paper, we discuss these differences based on a unique case of pure HCC, which developed in a small ectopic liver nodule in the pancreas.
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Abstract
RATIONALE Ectopic liver tissue can develop at various sites near the liver. Ectopic hepatocellular carcinomas (HCCs) arising from ectopic liver tissue have a rare clinical incidence. A very rare case has been observed to have metastasis after operation. PATIENT CONCERNS We report an extremely rare case with multiple masses which were identified in the head and body of the pancreas. DIAGNOSES Ectopic hepatocellular carcinomas. INTERVENTIONS The masses were removed by surgical resection. Histopathological analysis showed that both masses were ectopic HCC. OUTCOMES The patient was still alive and did not have metastasis and relapse. LESSONS The literature review for this rare case is also presented to highlight the risk of ectopic HCC and good prognosis of operation for ectopic HCC.
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Affiliation(s)
- Zhigui Li
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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12
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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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13
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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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14
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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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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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