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A 49-year-old woman presenting with hepatoid adenocarcinoma of the urinary bladder: a case report
© Sekino et al.; licensee BioMed Central Ltd. 2013
Received: 10 September 2012
Accepted: 30 November 2012
Published: 9 January 2013
Adenocarcinomas represent less than 2 percent of all urothelial neoplasms. Hepatoid adenocarcinoma is rare in the urinary bladder. Pathological diagnosis is based on a combination of histological features resembling hepatocellular carcinoma and positive immunostaining for α-fetoprotein.
We report a case of hepatoid adenocarcinoma of the urinary bladder. A 49-year-old Japanese woman underwent a total mastectomy, and post-operatively abdominal computed tomography revealed a tumor of the urinary bladder. Trans-urethral resection of the bladder tumor was performed, and pathological examination revealed a hepatoid adenocarcinoma of the urinary bladder. Our patient has had no evidence of recurrence 20 months after surgery to remove the tumor.
Hepatoid adenocarcinoma seems to be an aggressive malignant neoplasm that is rare in the urinary bladder. This case report is only the ninth case of hepatoid adenocarcinoma in the urinary bladder to appear in the literature. It is important to be aware of atypical cancer localizations in order to reach a correct diagnosis.
Hepatoid adenocarcinoma (HAC) is a very rare finding, and generally occurs in the stomach, ovaries, and lungs. The term hepatoid adenocarcinoma was first introduced by Ishikura et al. in 1985 . This report presents only the ninth case of HAC in the urinary bladder to be published in the literature, and reviews the previously reported cases.
HAC is a rare tumor, which is characterized by the morphological phenotype of a hepatocellular carcinoma. HAC is defined by the reproduction of a pattern similar to that of a hepatocellular carcinoma, with a combination of histopathological findings of solid nests and trabecular structures of polygonal atypical cells with wide granular cytoplasm and an immunochemical expression of AFP. Before a diagnosis of HAC is made, the metastases of a hepatocellular carcinoma should be ruled out.
Metzgeroth et al. recently published an evaluation of 262 HAC cases . The stomach was the most common location with a frequency of 63 percent, followed by the ovaries (10 percent), lungs (4 percent), gallbladder (3 percent), pancreas (4 percent), uterus (4 percent), and urinary bladder (3 percent). HAC usually presents in older patients. The male to female ratio was 2.4:1 and the median age at diagnosis was 65 years (range 21 to 88 years). HAC is treated like other adenocarcinomas of the common type, depending on the organ system involved. The prognosis of HAC is considered to be unfavorable. HAC is regarded to be an aggressive neoplasm associated with a high proportion of metastases at the time of diagnosis. The lymph nodes, the liver and the brain are common metastatic sites. The survival rate of 83 cases with various HAC indicated 43 patients had died within the first 12 months, and 40 patients were alive for more than 12 months. The one-year survival rate (expressed as a percentage) was about 55 percent and the median overall period of survival was 11 months (range 0 to 102 months) .
Characteristics of patients with hepatoid adenocarcinoma (HAC) in the urinary bladder
Case no., reference
1. Sinard 
2. Yamada 
Lost to follow-up
3. Burgues 
4. Lopez-Beltran 
Lung metastatsis, DOD
5. Lopez-Beltran 
Lung metastatsis, DOD
6. Lopez-Beltran 
Lung metastatsis, DOD
7. Lopez-Beltran 
8. Kawamura 
9. Present case
Hepatoid adenocarcinoma is a highly aggressive tumor mimicking the histological appearance of hepatocellular carcinoma. There are few reports describing hepatoid adenocarcinoma of the urinary bladder. It is important to be aware of atypical cancer localizations in order to reach a correct diagnosis.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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