Hepatoid carcinoma of the pancreas

World Journal of Surgical Oncology

Shin-E Wang²  Rheun-Chuan Lee³  Ying-Ju Kuo¹  Yi-Ming Shyr²  Shih-Chin Chen²  Po-Chung Kuo² 

[1] Department of Pathology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan;Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, 10 F 201 Section 2 Shipai Road, Taipei 112, Taiwan;Department of Radiology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan

关键词: Pancreatectomy;    Pancreas;    Hepatoid carcinoma;   

Others  :  1209008
DOI  :  10.1186/s12957-015-0586-6

 received in 2015-01-17, accepted in 2015-04-21,  发布年份 2015

【 摘 要 】

Background

Hepatoid carcinoma of the pancreas is extremely rare. This article tries to summarize the clinical features and outcomes of pancreatic hepatoid carcinoma.

Methods

The data pool for analysis includes the case we encountered with hepatoid carcinoma of the pancreas and the reported cases in the literature.

Results

Twenty-three cases of hepatoid carcinoma of the pancreas were analyzed. This tumor occurred more frequently in male than in female patients (69.6 vs. 30.4 %). Tumor sizes range from 0.5 to 11.0 cm with median of 6.0 cm. The most common symptom was epigastric pain (36.4 %). When the tumor locates at pancreatic head, nausea/vomiting (62.5 %) is more common, followed by jaundice and epigastric pain (50.0 %). For those at pancreatic body-tail, 42.9 % of the patients presented no symptom. Alpha-fetoprotein (AFP) was abnormally elevated in 60 % of the cases. Hepatoid carcinoma in the pancreas could be either pure form or mixed form with other malignancy (40.9 %), with the most common coexisted pathology of malignant neuroendocrine tumor (22.7 %). Metastasis occurred in 36.4 % of the cases at the diagnosis of this tumor, including liver metastasis in 31.8 % and lymph node metastasis in 21.1 %. The overall 1-year survival rate was 71.1 % and 5-year 40.4 %, with a median of 13.0 months. Unresectability, hepatic, and lymph node metastases are associated with negative impact on survival outcome.

Conclusions

Elevation of serum AFP may be a clue leading to the diagnosis of pancreatic hepatoid carcinoma. This tumor could be mixed form with other malignancy. Surgical resection should be the treatment of choice whenever possible.

【 授权许可】

   
2015 Kuo et al.; licensee BioMed Central.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Marchegiani G, Gareer H, Parisi A, Capelli P, Bassi C, Salvia R. Pancreatic hepatoid carcinoma: a review of the literature. Dig Surg. 2013; 30:425-33.
• [2]Majumder S, Dasanu CA. Hepatoid variant of pancreatic cancer: insights from a case and literature review. Jop. 2013; 14:442-5.
• [3]Petrelli F, Ghilardi M, Colombo S, Stringhi E, Barbara C, Cabiddu M et al.. A rare case of metastatic pancreatic hepatoid carcinoma treated with sorafenib. J Gastrointest Cancer. 2012; 43:97-102.
• [4]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.
• [5]Kai K, Nakamura J, Ide T, Masuda M, Kitahara K, Miyoshi A et al.. Hepatoid carcinoma of the pancreas penetrating into the gastric cavity: a case report and literature review. Pathol Int. 2012; 62:485-90.
• [6]Aoyama T, Mizuno T, Andoh K, Takagi T, Mizuno T, Eimoto T. alpha-Fetoprotein-producing (hepatoid) carcinoma of the fallopian tube. Gynecol Oncol. 1996; 63:261-6.
• [7]Gardiner GW, Lajoie G, Keith R. Hepatoid adenocarcinoma of the papilla of Vater. Histopathology. 1992; 20:541-4.
• [8]Hiroshima K, Iyoda A, Toyozaki T, Haga Y, Baba M, Fujisawa T et al.. Alpha-fetoprotein-producing lung carcinoma: report of three cases. Pathol Int. 2002; 52:46-53.
• [9]Ishikura H, Fukasawa Y, Ogasawara K, Natori T, Tsukada Y, Aizawa M. An AFP-producing gastric carcinoma with features of hepatic differentiation. A case report. Cancer. 1985; 56:840-8.
• [10]Hruban RH, Molina JM, Reddy MN, Boitnott JK. A neoplasm with pancreatic and hepatocellular differentiation presenting with subcutaneous fat necrosis. Am J Clin Pathol. 1987; 88:639-45.
• [11]Cardona D, Grobmyer S, Crawford JM, Liu C. Hepatocellular carcinoma arising from ectopic liver tissue in the pancreas. Virchows Arch. 2007; 450:225-9.
• [12]Hughes K, Kelty S, Martin R. Hepatoid carcinoma of the pancreas. Am Surg. 2004; 70:1030-3.
• [13]Ishikura H, Ishiguro T, Enatsu C, Fujii H, Kakuta Y, Kanda M et al.. Hepatoid adenocarcinoma of the renal pelvis producing alpha-fetoprotein of hepatic type and bile pigment. Cancer. 1991; 67:3051-6.
• [14]Ishikura H, Kirimoto K, Shamoto M, Miyamoto Y, Yamagiwa H, Itoh T et al.. Hepatoid adenocarcinomas of the stomach. An analysis of seven cases. Cancer. 1986; 58:119-26.
• [15]Lopez-Beltran A, Luque RJ, Quintero A, Requena MJ, Montironi R. Hepatoid adenocarcinoma of the urinary bladder. Virchows Arch. 2003; 442:381-7.
• [16]Nagai E, Ueyama T, Yao T, Tsuneyoshi M. Hepatoid adenocarcinoma of the stomach. A clinicopathologic and immunohistochemical analysis. Cancer. 1993; 72:1827-35.
• [17]Pitman MB, Triratanachat S, Young RH, Oliva E. Hepatocyte paraffin 1 antibody does not distinguish primary ovarian tumors with hepatoid differentiation from metastatic hepatocellular carcinoma. Int J Gynecol Pathol. 2004; 23:58-64.
• [18]Shintaku M, Kariya M, Shime H, Ishikura H. Adenocarcinoma of the uterine cervix with choriocarcinomatous and hepatoid differentiation: report of a case. Int J Gynecol Pathol. 2000; 19:174-8.
• [19]Tanigawa H, Kida Y, Kuwao S, Uesugi H, Ojima T, Kobayashi N et al.. Hepatoid adenocarcinoma in Barrett’s esophagus associated with achalasia: first case report. Pathol Int. 2002; 52:141-6.
• [20]Tochigi N, Kishimoto T, Supriatna Y, Nagai Y, Nikaido T, Ishikura H. Hepatoid carcinoma of the ovary: a report of three cases admixed with a common surface epithelial carcinoma. Int J Gynecol Pathol. 2003; 22:266-71.
• [21]Ulbright TM. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol. 2005; 18 Suppl 2:S61-79.
• [22]Yachida S, Fukushima N, Nakanishi Y, Akasu T, Kitamura H, Sakamoto M et al.. Alpha-fetoprotein-producing carcinoma of the colon: report of a case and review of the literature. Dis Colon Rectum. 2003; 46:826-31.
• [23]Paner GP, Thompson KS, Reyes CV. Hepatoid carcinoma of the pancreas. Cancer. 2000; 88:1582-9.
• [24]Metzgeroth G, Strobel P, Baumbusch T, Reiter A, Hastka J. Hepatoid adenocarcinoma—review of the literature illustrated by a rare case originating in the peritoneal cavity. Onkologie. 2010; 33:263-9.
• [25]Huang SC, Chang HC, Yeh TS, Ng KF, Chen TC. Hepatoid microcarcinoma of the pancreas: a case report and review of the literature. Chang Gung Med J. 2012; 35:285-91.
• [26]Yano T, Ishikura H, Wada T, Kishimoto T, Kondo S, Katoh H et al.. Hepatoid adenocarcinoma of the pancreas. Histopathology. 1999; 35:90-2.
• [27]Shih NN, Tsung JS, Yang AH, Tsou MH, Cheng TY. A unique pancreatic tumor with exclusive hepatocytic differentiation. Ann Clin Lab Sci. 2006; 36:216-21.
• [28]Matsueda K, Yamamoto H, Yoshida Y, Notohara K. Hepatoid carcinoma of the pancreas producing protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP). J Gastroenterol. 2006; 41:1011-9.
• [29]Liu CZ, Hu SY, Wang L, Zhi XT, Jin B, Zhu M et al.. Hepatoid carcinoma of the pancreas: a case report. Chin Med J (Engl). 2007; 120:1850-2.
• [30]Kubota K, Kita J, Rokkaku K, Iwasaki Y, Sawada T, Imura J et al.. Ectopic hepatocellular carcinoma arising from pancreas: a case report and review of the literature. World J Gastroenterol. 2007; 13:4270-3.
• [31]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.
• [32]Ishikura H, Kishimoto T, Andachi H, Kakuta Y, Yoshiki T. Gastrointestinal hepatoid adenocarcinoma: venous permeation and mimicry of hepatocellular carcinoma, a report of four cases. Histopathology. 1997; 31:47-54.
• [33]Oh HJ, Cheung DY, Kim TH, Kim SS, Kim MS, Kim JI et al.. A case of hepatoid carcinoma of the pancreas. Korean J Gastroenterol. 2006; 47:389-93.
• [34]Cuilliere P, Lazure T, Bui M, Fabre M, Buffet C, Gayral F et al.. Solid adenoma with exclusive hepatocellular differentiation: a new variant among pancreatic benign neoplasms? Virchows Arch. 2002; 441:519-22.
• [35]Tanno S, Obara T, Fujii T, Izawa T, Mizukami Y, Saitoh Y et al.. alpha-Fetoprotein-producing adenocarcinoma of the pancreas presenting focal hepatoid differentiation. Int J Pancreatol. 1999; 26:43-7.
• [36]Jung JY, Kim YJ, Kim HM, Kim HJ, Park SW, Song SY et al.. Hepatoid carcinoma of the pancreas combined with neuroendocrine carcinoma. Gut Liver. 2010; 4:98-102.
• [37]Collan Y, Hakkiluoto A, Hastbacka J. Ectopic liver. Ann Chir Gynaecol. 1978; 67:27-9.
• [38]Watanabe M, Matsura T, Takatori Y, Ueki K, Kobatake T, Hidaka M et al.. Five cases of ectopic liver and a case of accessory lobe of the liver. Endoscopy. 1989; 21:39-42.
• [39]Rao MS, Reddy JK. Hepatic transdifferentiation in the pancreas. Semin Cell Biol. 1995; 6:151-6.
• [40]Reddy JK, Rao MS, Yeldandi AV, Tan XD, Dwivedi RS. Pancreatic hepatocytes. An in vivo model for cell lineage in pancreas of adult rat. Dig Dis Sci. 1991; 36:502-9.
• [41]Seufferlein T, Bachet JB, Van Cutsem E, Rougier P. Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012; 23 Suppl 7:vii33-40.
• [42]Lam K, Lo C, Wat M, Fan ST. Malignant insulinoma with hepatoid differentiation: a unique case with alpha-fetoprotein production. Endocr Pathol. 2001; 12:351-4.
• [43]Lattes C, Carella R, Faggioli S, Gabusi E, Grigioni WF. Hepatoid adenocarcinoma of the rectum arising in ulcerative colitis: report of a case. Dis Colon Rectum. 2000; 43:105-8.
• [44]Nakao A, Taniguchi K, Inoue S, Takeda S, Harada A, Nonami T et al.. Clinical application of a new monoclonal antibody (19B7) against PIVKA-II in the diagnosis of hepatocellular carcinoma and pancreatobiliary malignancies. Am J Gastroenterol. 1997; 92:1031-4.