Bladder
Adenocarcinoma
Hepatoid adenocarcinoma

Author: Rugvedita Parakh, M.D. (see Authors page)

Revised: 1 August 2016, last major update December 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Bladder hepatoid adenocarcinoma
Definition / General
  • 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
Treatment
  • Cystoprostatectomy or by transurethral resection of the bladder
Micro Description
  • 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

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AFP+

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