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Pablo-Martín E, Corvo-Félix L, Roldán Ruiz J, Redondo González JC, Cuesta Martínez L, Reguera Puertas P, Figuero-Pérez L, Fonseca-Sánchez E. A rare case of hepatoid gastric adenocarcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38305676 DOI: 10.17235/reed.2024.10285/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Hepatoid gastric adenocarcinoma (HGA) is a rare subtype of gastric cancer. It usually presents with non-specific digestive tract symptoms and is usually diagnosed in advanced stages. It has radiological and histological similarities to hepatocarcinoma (HCC), and serum elevation of alpha-fetoprotein (AFP) is characteristic, as is positive staining for this marker on immunohistochemistry. Given the low incidence and poor prognosis of this type of tumour, it is essential to make a correct differential diagnosis and to initiate early surgical treatment in localised stages and systemic treatment in those where the disease is disseminated. In this context, we present the case of a GHA diagnosed this year in our centre.
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Dong C, Wang Y, Gu X, Lv X, Ren S, Wang Z, Dai Z. Differential diagnostic value of tumor markers and contrast-enhanced computed tomography in gastric hepatoid adenocarcinoma and gastric adenocarcinoma. Front Oncol 2023; 13:1222853. [PMID: 37538113 PMCID: PMC10396771 DOI: 10.3389/fonc.2023.1222853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023] Open
Abstract
Objective This study aimed to investigate the effectiveness of tumor markers and contrast-enhanced computed tomography (CE-CT) in differentiating gastric hepatoid adenocarcinoma (GHA) from gastric adenocarcinoma (GA). Methods This retrospective study included 160 patients (44 with GHA vs. 116 with GA) who underwent preoperative CE-CT. Preoperative serum concentrations of tumor biomarkers and CT imaging features were analyzed, including alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), tumor location, growth pattern, size, enhancement pattern, cystic changes, and mass contrast enhancement. Multivariate logistic regression analyses were performed to evaluate useful tumor markers and CT imaging features for differentiating GHA from GA. Results When compared to GA, GHA showed a higher serum AFP [13.27 ng/ml (5.2-340.1) vs. 2.7 ng/ml (2.2-3.98), P <0.001] and CEA levels [4.07 ng/ml (2.73-12.53) vs. 2.42 ng/ml (1.38-4.31), P <0.001]. CT imaging showed GHA with a higher frequency of tumor location in the gastric antrum (P <0.001). GHA had significantly lower attenuation values at the portal venous phase [PCA, (82.34 HU ± 8.46 vs. 91.02 HU ± 10.62, P <0.001)] and delayed phase [DCA, (72.89 HU ± 8.83 vs. 78.27 HU ± 9.51, P <0.001)] when compared with GA. Multivariate logistic regression analyses revealed that tumor location, PCA, and serum AFP level were independent predictors of differentiation between GHA and GA. The combination of these three predictors performed well in discriminating GHA from GA, with an AUC of 0.903, a sensitivity of 86.36%, and a specificity of 81.90%. Conclusions Integrated evaluation of tumor markers and CT features, including tumor location, PCA, and serum AFP, allowed for more accurate differentiation of GHA from GA.
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Affiliation(s)
- Congsong Dong
- Department of Radiology, Affiliated Hospital 6 of Nantong University (Yancheng Third People’s Hospital), Yancheng, China
| | - Yanling Wang
- Department of Radiology, The People’s Hospital of Suzhou New District, Suzhou, China
| | - Xiaoyu Gu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaojing Lv
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuai Ren
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhenyu Dai
- Department of Radiology, Affiliated Hospital 6 of Nantong University (Yancheng Third People’s Hospital), Yancheng, China
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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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Restaino S, Pellecchia G, Poli A, Arcieri M, Andreetta C, Mariuzzi L, Orsaria M, Biasioli A, Della Martina M, Intini SG, Scambia G, Driul L, Vizzielli G. A Rare Case of Hepatocellular Carcinoma Recurrence in Ovarian Site after 12 Years Mimicking a Hepatoid Adenocarcinoma: Case Report. J Clin Med 2023; 12:jcm12072468. [PMID: 37048552 PMCID: PMC10095375 DOI: 10.3390/jcm12072468] [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: 02/05/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Hepatoid carcinoma of the ovary (HCO) is a tumor that resembles, both histologically and cytologically, hepatocarcinoma (HCC) in a patient with a non-cirrhotic liver not involved by the disease. Hepatoid carcinoma is an extremely rare histologic subtype of ovarian cancer and should be distinguished from metastatic HCC. Here, we report the rare case of a 67-year-old woman with ovarian recurrence of HCC 12 years after first diagnosis. The patient was being followed by oncologists because she had been diagnosed with HCV-related HCC (Edmonson and Stainer grade 2, pT2 N0 M0, G2, V1) in 2009. She had undergone surgery for enlarged left hepatectomy to the 4th hepatic segment with cholecystectomy and subsequent placement of a Kehr drain. The preoperative alpha-fetoprotein (AFP) level was 8600 ng/mL, while the postoperative value was only 2.7 ng/mL. At the first diagnosis, no other localizations of the disease, including the genital tract, were found. At the time of recurrence, however, the patient was completely asymptomatic: her liver function was within normal limits with negative blood indices, except for an increased blood dosage of AFP (467 ng/mL), and CA125, which became borderline (37.4 IU/mL). The oncologist placed an indication for a thoracic abdominal CT scan, which showed that the residual liver was free of disease, and the presence of a formation with a solid-cystic appearance and some calcifications at the left adnexal site. The radiological findings were confirmed on level II gynecological ultrasound. The patient then underwent a radical surgery of hysterectomy, bilateral oophorectomy, pelvic peritonectomy, and omentectomy by a laparotomic approach, with the sending of intraoperative extemporaneous histological examination on the annexus site of the tumor mass, obtaining RT = 0. Currently, the patient continues her gyneco-oncology follow-up simultaneously clinically, in laboratory, and instrumentally every 4 months. Our study currently represents the longest elapsed time interval between first diagnosis and disease recurrence, as evidenced by current data in the literature. This was a rather unique and difficult clinical case because of the rarity of the disease, the lack of scientific evidence, and the difficulty in differentiating the primary hepatoid phenotype of the ovary from an ovarian metastasis of HCC. Several multidisciplinary meetings for proper interpretation of clinical and anamnestic data, with the aid of immunohistochemistry (IHC) on histological slides were essential for case management.
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Affiliation(s)
- Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n°15, 33100 Udine, Italy
| | - Giulia Pellecchia
- Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Alice Poli
- Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Martina Arcieri
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n°15, 33100 Udine, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122 Messina, Italy
| | - Claudia Andreetta
- Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)-Ospedale S. Maria della Misericordia, 33100 Udine, Italy
| | - Laura Mariuzzi
- Medical Area Department, Institute of Pathological Anatomy, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Maria Orsaria
- Medical Area Department, Institute of Pathological Anatomy, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Anna Biasioli
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n°15, 33100 Udine, Italy
| | - Monica Della Martina
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n°15, 33100 Udine, Italy
| | - Sergio Giuseppe Intini
- Department of General Surgery, Academic Hospital of Udine, University of Udine, 33100 Udine, Italy
| | - Giovanni Scambia
- Institute of Gynaecology and Obstetrics Clinic, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenza Driul
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n°15, 33100 Udine, Italy
- Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, Azienda Ospedaliera Universitaria Friuli Centrale, ASUFC, 33100 Udine, Italy
| | - Giuseppe Vizzielli
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n°15, 33100 Udine, Italy
- Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, Azienda Ospedaliera Universitaria Friuli Centrale, ASUFC, 33100 Udine, Italy
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