Hepatoid adenocarcinoma of the lung: a case report and review of the literature. J Gastrointest Cancer. 2014;45 Suppl 1:99-102. [PMID: 24408270 DOI: 10.1007/s12029-013-9558-7]

Primary hepatoid adenocarcinoma of lung: A rare malignancy mimicking tuberculosis

Hepatoid adenocarcinoma of lung (HAL) is a rare aggressive malignant tumour which histologically resembles hepatocellular carcinoma (HCC). Hepatoid adenocarcinoma (HAC) mostly produces high levels of alphafetoprotein (AFP) and is frequently found in extrahepatic organs including stomach, testes, ovaries, lungs and pancreas. Our patient was a male in his 40s with a chronic smoking history, presented with complaints of fever, weight loss, cough and anorexia for one month. On the basis of history, examination and initial investigation patient were started on empirical antitubercular therapy. However, within a span of 10 days, patient's condition worsened, and he developed a pulmonary embolism, which despite adequate treatment did not improve and the patient succumbed to his illness. Postmortem biopsy revealed a rare primary lung tumour, HAL.

A case report of pulmonary hepatoid adenocarcinoma: promoting standardized diagnosis and treatment of the rare disease

Objective

To investigate the clinical features, pathological characteristics, immunophenotype, differential diagnosis and prognosis of pulmonary hepatoid adenocarcinoma using a clinical case and literature report.

Methods

We analyzed the clinical presentation, histological pattern and immunohistochemistry of a case of primary hepatoid adenocarcinoma of the lung in April 2022. We also reviewed literature on hepatoid adenocarcinoma of the lung from PubMed database.

Results

The patient was a 65-year-old male with smoking history, who was admitted to hospital with an enlarged axillary lymph node. The mass was round, hard, and grayish-white and grayish-yellow in color. Microscopically, it presented hepatocellular carcinoma-like and adenocarcinoma differentiation features, with abundant blood sinuses visible in the interstitium. Immunohistochemistry showed that the tumor cells were positive for hepatocyte markers, including AFP, TTF-1, CK7 and villin, and negative for CK5/6, CD56, GATA3, CEA and vimentin.

Conclusion

Pulmonary hepatoid adenocarcinoma is a rare epithelial malignancy of primary origin in the lung with poor prognosis. Establishing the diagnosis relies mainly on the detection of hepatocellular structural morphology resembling hepatocellular carcinoma, and on clinicopathological and immunohistochemical testing to exclude diseases such as hepatocellular carcinoma. Combination treatment, mainly surgery, can prolong the survival of early-stage cases of the disease, whereas radiotherapy is mostly used for intermediate and advanced cases. Individualized treatment with molecular-targeted drugs and immunotherapy has shown different therapeutic effects for different patients. Further research is needed to better understand this rare clinical condition for the development and optimization of treatment strategies.

Hepatoid Adenocarcinoma of the Lung: A Review of the Most Updated Literature and a Presentation of Three Cases

In a Surgical Thoracic Center, two females and a man were unexpectedly diagnosed with hepatoid adenocarcinoma of the lung (HAL) in a single year. HAL is a rare lung cancer with pathological features of hepatocellular carcinoma with no evidence of liver tumor or other primitive sites of neoplasms. As of today, a comprehensive treatment is still not written. We reviewed the most updated literature on HAL, aiming to highlight the proposed treatments available, and comparing them in terms of survival. General hallmarks of HAL are confirmed: it typically affects middle-aged, heavy-smoker males with a median of 5 cm bulky right upper lobe mass. Overall survival remains poor (13 months), with a longer but non-significant survival in females. Treatments are still unsatisfactory today: surgery guarantees a small benefit compared to non-operated HALs, and only N0 patients demonstrated improved survival (p = 0.04) compared to N1, N2, and N3. Even though the histology is fearsome, these are probably the patients who will benefit from upfront surgery. Chemotherapy seemed to behave as surgery, and there is no statistical difference between chemotherapy only, surgery, or adjuvant treatments, even though adjuvant treatments tend to be more successful. New chemotherapies have been reported with notable results in recent years, such as Tyrosine Kinase Inhibitors and monoclonal antibodies. In this complicated picture, new cases are needed to further build shared evidence in terms of diagnosis, treatments, and survival opportunities.

Primary Hepatoid Adenocarcinoma of the Lung: A Systematic Literature Review

Background

Hepatoid adenocarcinoma (HAC) of the lung (HAL) is a rare and aggressive extrahepatic adenocarcinoma with an unknown etiology and unfavorable prognosis, which is similar to the pathophysiological characteristics of hepatocellular carcinoma (HCC).

Methods

We first presented a 67-year-old patient diagnosed with HAC in the right middle lobe of the lung. Then, a systematic literature search was performed for HAL cases recorded between 1990 and 2020 based on three databases. The clinicopathological features, therapeutic method, and prognosis of this rare disease were reviewed, and corresponding prognostic factors were explored using Kaplan–Meier (K-M) curve and Cox proportional hazards regression model. Additionally, the potential biological mechanisms of HAL were further explored and compared with HCC and lung adenocarcinoma (LUAD) based on online databases.

Results

In the present study, we reported an HAL patient who underwent surgical resection combined with chemotherapy and succumbed to disease 13 months after surgery. Additionally, a total of 43 experimental studies with 49 HAL patients, including the present case, met the inclusion criteria and were included in the present review. We found that HAL is characterized by a male-dominated incidence and is more common in the right lung. Patients in the surgical subgroup have a better prognosis than those in the non-surgical subgroup (p = 0.034). Moreover, the Cox proportional hazards regression model demonstrated that surgical resection can significantly improve the prognosis of HAL patients (p = 0.016). HAL is a rare disease associated with gene mutations that has a distinctive cause and unique pathogenesis. Additionally, Afatinib and Gefitinib may be new effective agents to better combat HAL.

Conclusion

In conclusion, males may exhibit an increased risk of developing HAL and poorer prognosis than females. Surgical resection combined with chemotherapy may prolong the survival of patients with HAL. HAL has its unique clinicopathological characteristics and biological mechanisms.

Clinicopathological features and genomic profiles of hepatoid adenocarcinoma of the lung: Report of four cases

OBJECTIVE

Pathological features of hepatoid adenocarcinoma of the lung (HAL) are similar to those of hepatocellular carcinoma (HCC) and HAL has a poor prognosis. In this study, we aimed to elucidate clinicopathologic and molecular features of HAL.

METHODS

Four cases of HAL patients with one lobe of the lung resected were enrolled into the study. Next generation sequencing (NGS) of a 425-gene panel was performed on tumor tissue samples.

RESULTS

The most frequently mutated gene was TP53 in three cases of primary HAL and one case of metastatic HAL, with a mutation rate of 100%. Also, CDK8, CDKN2A, EPHA5, SMARCA4, and STK11 were detected as high-frequency mutations, with a mutation rate of 50%. The types of TP53 mutation included two missense variants and two frameshift ones. The TP53 mutation was related to the occurrence of HAL.

CONCLUSION

HAL could be caused by genetic mutations and is closely related to TP53 mutation.

Alpha-fetoprotein-producing recurrent nasopharyngeal carcinoma: A case report

Alpha-fetoprotein hardly increased due to nasopharyngeal cancer. In this article, we reported a 57-year-old male nasopharyngeal carcinoma patient who had posttreatment subscapular metastasis with high serum alpha-fetoprotein but negative plasma Epstein–Barr virus DNA. Pathology results indicated that the scapular mass was undifferentiated non-keratinizing carcinoma originated in the nasopharynx. Moreover, no liver lesion was detected by imaging examination. In view of the positive alpha-fetoprotein and alpha-fetoprotein messenger RNA staining result in the right scapular mass fine needle aspiration biopsy sample, we considered the diagnosis of alpha-fetoprotein-producing nasopharyngeal carcinoma that had never been reported before.

Clinical characteristics of Hepatoid adenocarcinoma of the lung: Four case reports and literature review

PURPOSE

Hepatoid adenocarcinoma of the lung (HAL) is a rare form of lung cancer, which is characterized by its morphologic hepatoid features. The clinical characteristics and prognosis of this rare form of lung cancer remain obscure.

METHODS

The clinical courses of four cases of HAL were reported. A literature search was performed up to December 31, 2020, using the electronic databases PubMed and Web of Science.

RESULTS

Including the present 4 cases, a total of 42 cases of HAL have been reported in the literature. The median age was 58.5 years old (range, 36-73 years). 36 (85.7%) patients were male. 26 (61.9%) patients had a history of smoking, the median amount of smoking was 40 pack years (range, 8-180). The most common site of the primary tumor was the right upper lobe (22 cases, 52.3%) and the left upper lobe (10 cases, 23.8%). 21 patients (50%) had pretreatment serum AFP levels higher than the upper limit, and 4 patients (9.5%) had normal pretreatment serum AFP levels. Treatment of HAL included surgery, chemotherapy, radiotherapy, tyrosine kinase inhibitors (TKIs), anti-angiogenesis therapy, and anti-PD-1/PD-L1 monoclonal antibody. Overall, the prognosis of HAL was poor, with median overall survival (OS) of 14 months.

CONCLUSIONS

HAL is an aggressive tumor, with a poor prognosis and male predominance, which tends to occur in heavy smokers and affects the right upper lobe of the lung.

Hepatoid Adenocarcinoma of the Lung: A Systematic Review of the Literature From 1981 to 2020

Objectives

We report the first case of hepatoid adenocarcinoma of the lung (HAL) with PIK3CA mutation. In addition, we analyzed data from HAL cases over the past 40 years to study its main treatment methods, prognosis, and the relationship between prognosis and the serum alpha-fetoprotein (AFP) level before treatment.

Methods

We report a 66-year-old male case who was diagnosed with locally advanced HAL with PIK3CA mutation and carried out a systematic literature search for HAL cases documented between 1981 and 2020. General patient information including case characteristics was extracted and summarized. The median OS (mOS) of HAL patients was determined using the KM survival curve. The Cox proportional hazards regression model was used to evaluate the effect of tumor size, location, and serum AFP value before treatment and radical surgery (RS) on the prognosis of patients.

Results

A total of 46 studies including 51 HAL patients was included in our review. Our study revealed that 52.9% of tumors were located in the upper lobe of the right lung. The proportion of serum AFP-positive patients before treatment, early-stage patients (TNM stage I and II), and patients who had received surgery were 69.2%, 34.1%, and 40%, respectively. The mOS of HAL patients was 16.0 months. The 2-year and 5-year survival rates of the patients were 35.3% and 8.0%, respectively. In the subgroup analysis, the 2-year survival rate for patients who received RS was 62.5%, while for patients who were unable to undergo RS, it was only 12.5% (p = 0.009). The Cox proportional hazards regression model indicated that RS can significantly improve the prognosis of HAL patients (p = 0.011), although the location and size of tumor as well as the serum AFP value before treatment had no significant effect on their prognosis (p = 0.82, p = 0.96, p = 0.25).

Conclusions

HAL patients have a poor prognosis, and the survival benefits for patients receiving chemoradiotherapy or chemotherapy alone appear to be limited. We demonstrate statistically for the first time that pretreatment serum AFP values are not related to the prognosis of HAL patients and RS can significantly improve patient prognosis.

Primary Hepatoid Adenocarcinoma of the Lung: A Study of Two Cases with Review of Literature

Primary hepatoid adenocarcinoma (HAC) is a rare extrahepatic adenocarcinoma with morphological and phenotypical resemblance to hepatocellular carcinoma (HCC). It can occur in lung, stomach, gallbladder, pancreas, ovary, and uterus, with most common site being stomach. Morphological features of primary HAC of the lung are similar to HCC, so exclusion of metastatic HCC is necessary. In this report, we describe two cases of elderly men with primary pulmonary HAC who presented in advanced clinical stage and diagnosed by fine-needle aspiration cytology with immunohistochemistry. Both patients succumbed to death despite starting first cycle of chemotherapy.

Radiotherapy of Pulmonary Hepatoid Adenocarcinoma with Intrahepatic Hemangioma: A Case Report

Hepatoid adenocarcinoma is defined as an extrahepatic adenocarcinoma with hepatocyte differentiation, characterized by high malignancy and poor prognosis. Herein, we report the diagnosis, treatment and survival of a patient with pulmonary hepatoid adenocarcinoma who had received radiotherapy only. The patient was a 41-year-old man diagnosed with local advanced lung cancer (T3N3M0, stage IIIC). He had an intrahepatic hemangioma and abnormal serum liver enzymes. The patient developed intermittent fever with increased white blood cells and granulocytes during radiotherapy. After 38Gy/19 fractions of radiotherapy, the blood routine results returned to normal levels. After 50Gy/25 fractions of radiotherapy, the patient’s tumor was significantly shrank in imaging. Although the patient refused to receive any treatment after radiotherapy and died 12 months after diagnosis, the data presented here represent a valuable resource for understanding the survival benefits of pulmonary hepatoid adenocarcinoma patients treated with radiotherapy alone.

Anti-PD-1 Therapy Achieved Disease Control After Multiline Chemotherapy in Unresectable KRAS-Positive Hepatoid Lung Adenocarcinoma: A Case Report and Literature Review

Hepatoid adenocarcinoma of the lung (HAL) is extremely rare and standardized treatment strategy for HAL has not been established. Patients with unresectable HAL have a shorter survival time ranges from 1 to 36 months. Here, we reported a 65-year-old female patient with unresectable alpha-fetoprotein-producing HAL harboring KRAS-G12V and no other targetable driver mutations. The patient was treated with multiple lines of chemotherapies followed by PD-1 inhibitor, sintilimab, due to positive staining of PD-L1, and achieved an overall survival of 52 months. Although the disease was under control, the patient experienced fifth-grade pneumonia and died after 6 months of anti-PD-1 treatment. This is the first case of KRAS-positive HAL patient achieved stable disease by PD-1 inhibitor, which may provide valuable information for the treatment strategy development of advanced HAL patients, and highlights the importance of molecular diagnosis in treatment decision-making.

Hepatoid adenocarcinoma of the lung mimicking metastatic hepatocellular carcinoma

Hepatoid adenocarcinoma of the lung is a rare subtype of lung cancer. We report a case of a metastatic hepatoid adenocarcinoma of the lung with aggressive behavior, including biopsy and autopsy findings. The pulmonary tumors showed features indistinguishable from hepatocellular carcinoma and were diffusely positive for Hepatocyte Paraffin 1.

Hepatoid adenocarcinoma of the lung and the review of the literature

INTRODUCTION

Hepatoid adenocarcinoma of the lung is an extremely rare type of the non-small cell lung cancer. Treatment principles and prognosis are similar to that of lung adenocarcinoma.

CASE REPORT

A 62-year-old female smoker presented with a huge mass in the left upper lobe. After diagnostic biopsy, she underwent left pneumonectomy and mediastinal lymph node dissection. A diagnosis of stage T4N1M0 hepatoid adenocarcinoma of the lung with positive surgical margins was made.

MANAGEMENT AND OUTCOME

After the operation, the level of serum alpha fetoprotein was 9010 ng/ml (N: <10). The level of serum alpha fetoprotein was decreased with concurrent chemoradiotherapy and chemotherapy. Disease progression was detected at 11 months after diagnosis. No response was obtained to other therapies. The patient died at 14 months from the time of diagnosis.

DISCUSSION

Usually, patients with hepatoid adenocarcinoma of the lung are male smokers. Hepatoid adenocarcinoma tends to settle in the upper lobes of the lung. The most important prognostic factor of the hepatoid adenocarcinoma of the lung is the disease stage at the diagnosis and patients with metastatic disease have poor survival.

Primary hepatoid adenocarcinoma of the lung in Yungui Plateau, China: A case report

BACKGROUND

Hepatoid adenocarcinoma (HAC) occurs in extrahepatic organs such as the gastrointestinal tract, testes, ovaries, lungs, mediastinum and pancreas, and frequently produces α-fetoprotein (AFP). HAC of the lung (HAL) is rare, characterized by difficult treatment and poor prognosis. There are no reports of HAL in Yunnan-Guizhou Plateau, China.

CASE SUMMARY

A 60-year-old male patient was clinically diagnosed with HAL pT3N0M0, stage IIB. Chest computed tomography revealed a 7.5 cm × 7.2 cm soft tissue mass located in the right lung upper lobe and the adjacent superior mediastinum. Right upper lobectomy was performed. The diagnosis of HAL was confirmed by pathological examination, and the patient received paclitaxel and carboplatin as adjuvant chemotherapy after surgery.

CONCLUSION

Clinical manifestations, pathological features, imaging findings, auxiliary examination, and treatment planning of HAL are presented to help clinicians improve their diagnosis and treatment.

Primary pulmonary hepatoid adenocarcinoma: A case report and review of the literature

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.

FDG PET/CT in Hepatoid Adenocarcinoma of the Lung

A right upper lung mass was incidentally found on a chest radiograph in a routine health examination in a 56-year-old man. The mass showed mild heterogeneous enhancement on contrast chest CT images and intense FDG uptake on PET/CT images. Pathological examination demonstrated hepatoid adenocarcinoma in the lung.

Hepatoid adenocarcinoma of the lung: Review of a rare form of lung cancer

RATIONALE

Hepatoid adenocarcinoma (HAC) is a rare malignant lung tumor that histologically resembles typical hepatocellular carcinoma (HCC) when it is metastatic to the lung. To date, this clinical entity has not been highlighted in the pulmonary literature.

OBJECTIVE

We present a review of all known cases of HAC, including the relevant clinical and histopathological features important for pulmonologists.

MEASUREMENTS AND MAIN RESULTS

The purpose of this report is to present a new case of HAC, with typical clinical and histologic features of this malignancy, and to summarize findings of previously reported cases. A systematic literature search of the electronic database PUBMED was conducted to identify all cases of hepatoid adenocarcinoma reported in the English literature, between January 1980 and June 2015. HAC and HCC can be distinguished by immunohistochemical staining. HAC usually presents as a large bulky solitary mass in the upper lobe; there is an exceedingly high prevalence in males and most patients with this tumor are smokers. Serum alpha-fetoprotein (AFP) in very high levels has been a distinguishing feature of this tumor. Nodal and distant metastases are common at initial presentation and, as a result, the prognosis is very poor. Resection and long-term survival, however, have been reported.

CONCLUSION

Hepatoid adenocarcinoma, first described as a gastric tumor, has also been described in the lung. It morphologically resembles and must be distinguished from metastatic HCC of the lung. While most tumors produce AFP, the case we present demonstrates that this should not be a criterion for diagnosis.

Hepatoid adenocarcinoma of the lung without production of α-fetoprotein: A case report and review of the literature

Hepatoid adenocarcinoma of the lung (HAL) is a rare type of extrahepatic hepatoid adenocarcinoma. The majority of such cases that have been reported in the English literature have demonstrated elevated serum α-fetoprotein (AFP) and/or positive AFP expression on histopathological analysis, and have had poor prognoses. The current study reports an extremely rare case of HAL in the right upper lung without AFP production in a 59-year-old male patient. The patient underwent radical right upper lobectomy via video assisted thoracoscopic surgery. No signs of local recurrence or distant metastasis have been observed for 23 months after the surgery. The serum AFP level following surgery remained within the normal range. Although the diagnosis of HAL predominantly depends on pathological examination, a review of the literature demonstrates that HAL has certain characteristic features with regard to its clinical and computed tomography findings and prognoses, and clinicians should be aware that clinicians should be aware that monitoring serum AFP levels, as well as CT findings, remains important.