J Korean Surg Soc.  2011 Jun;80(6):440-444. 10.4174/jkss.2011.80.6.440.

Hepatoid adenocarcinoma of the gallbladder with production of alpha-fetoprotein

• Lee JH
• Lee KG
• Paik SS
• Park HK
• Lee KS

• KMID: 2212191
• DOI: http://doi.org/10.4174/jkss.2011.80.6.440

Abstract

Hepatoid adenocarcinoma (HAC) is a tumor with aberrant hepatocellular differentiation that occurs in extrahepatic organs. HAC of the gallbladder is rare, and cases of alpha-fetoprotein production are extremely rare. A 61-year-old man was diagnosed with gallbladder adenocarcinoma after laparoscopic cholecystectomy. A radical operation including resection of liver bed and lymph node dissection was performed, and no tumor cell was found. However, at postoperative 19 months, he showed lymphadenopathy of the portocaval area and tumor thrombi in the right portal vein with high levels of serum alpha-fetoprotein. After right hemihepatectomy and portahepatis lymph node dissection was performed, he was diagnosed with metastatic HAC. On reviewing the gallbladder specimen, the tumor finally demonstrated HAC as the primary origin. Despite adjuvant therapy, the patient died from multiple liver metastasis 26 months after cholecystectomy. Although HAC of the gallbladder is a very rare malignancy, awareness of its existence is critical to avoid misdiagnosis.

Keyword

Hepatoid adenocarcinoma; Gallbladder; Alpha-fetoprotein

MeSH Terms

Adenocarcinoma
alpha-Fetoproteins
Cholecystectomy
Cholecystectomy, Laparoscopic
Diagnostic Errors
Gallbladder
Humans
Liver
Lymph Node Excision
Lymphatic Diseases
Middle Aged
Neoplasm Metastasis
Portal Vein
alpha-Fetoproteins

Figure

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  Fig. 1 (A) Abdominal computed tomography (CT) revealed the necrotic lymphadenopathy with infiltration of the portocaval area and thrombosis in the main and right portal vein. (B1 and B2) Positron emission tomography/CT showed the hypermetabolic lesion of 4 × 3 cm in portocaval area. (C) The cut surface of liver showed a well demarcated mass with a central bright yellowish area in the right portal vein.

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  Fig. 2 (A) Highly pleomorphic cells arranged in a rosettoid, nested, or trabecular pattern with relatively clear cytoplasm, enlarged nuclei, and prominent nucleoli. Numerous hyaline globules are noted in the intercellular or intracellular areas (H&E ×200). Immunohistochemical staining for alpha-fetoprotein (B) and alpha1-antitrypsin (C) showed strongly positive in the hepatoid area of the liver (×200).

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  Fig. 3 (A) The gallbladder wall is replaced with infiltrating hepatoid adenocarcinoma composed of solid area, hepatoid carcinoma, with hyaline globules and conventional adenocarcinomatous area (H&E, ×200). Immunohistochemical staining for alpha-fetoprotein (B) and alpha1-antitrypsin (C) was positive in the hepatoid area of the previously operated gallbladder specimen (×200).

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