Bladder - Hepatoid adenocarcinoma

Home Chapter Home Jobs Conferences Fellowships Books

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
=========================================================================

● 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
=========================================================================

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

Clinical features
=========================================================================

● 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
=========================================================================

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

Treatment
=========================================================================

● Cystoprostatectomy or by transurethral resection of the bladder

Micro
=========================================================================

● 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
=========================================================================

Gastric tumor

AFP+

Lung tumor

Ovarian tumor

Pancreatic tumor

Positive stains
=========================================================================

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

Differential diagnosis
=========================================================================

● 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

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).