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Bladder

Other Carcinomas

Hepatoid adenocarcinoma


Reviewers: Rugvedita Parakh, M.D., HCG Oncology (see Reviewers page)
Revised: 7 June 2011, last major update June 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Very rare urothelial carcinoma with hepatoid differentiation
● Diagnosed based on microscopic features resembling hepatocellular carcinoma and positive immunostaining for alpha-fetoprotein, with no history or primary lesion in liver
● "Hepatoid" is used for either (1) germ cell tumors with focal hepatoid areas or (2) true hepatoid adenocarcinomas that meet histologic and immunohistochemical criteria for hepatocellular differentiation
● AFP-producing tumors with no other features of hepatocellular differentiation should not be termed hepatoid tumors

Epidemiology
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● < 50 well-documented cases
● More common in males
● Usually > 60 years of age

Clinical features
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● Presents with hematuria
● Aggressive, often death due to disease within 2 years after diagnosis
● Correct diagnosis requires immunohistochemistry and in situ hybridization with a complete clinical and pathological evaluation
● Note: serum AFP is nonspecific; may be produced by hepatoid or non-hepatoid bladder carcinomas

Case reports
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● 71 year old man (Virchows Arch 1999;435:71)
● 79 year old man (Hinyokika Kiyo 2009;55:619)

Treatment
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● Cystoprostatectomy or by transurethral resection of the bladder

Micro
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● Mixture of large polygonal (hepatoid) cells growing in sheets and solid fashion or anastomosing trabeculae merging with a secondary glandular pattern of adenocarcinoma
● Large cells have eosinophilic cytoplasm and are separated by sinusoids, resembling hepatocellular carcinoma
● Often intracytoplasmic hyaline globules and bile production (Virchows Arch 2003;442:381)

Micro images
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Gastric tumor


AFP+


Lung tumor


Ovarian tumor

Pancreatic tumor

Positive stains
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● Alpha-fetoprotein (AFP), alpha-1-antitrypsin, low molecular weight keratin, EMA, pCEA (canalicular pattern)
● Also HEPPAR1, albumin (IHC and mRNA)

Differential diagnosis
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Metastatic carcinoma: Either hepatoid adenocarcinoma or hepatocellular carcinoma
Urachal adenocarcinoma: may be AFP+, but lacks other markers of hepatic differentiation

End of Bladder > Other Carcinomas > Hepatoid adenocarcinoma


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