Hepatoid adenocarcinoma of the lung mimicking metastatic hepatocellular carcinoma

Hepatoid adenocarcinoma of the lung is a rare subtype of lung cancer. We report a case of a metastatic hepatoid adenocarcinoma of the lung with aggressive behavior, including biopsy and autopsy findings. The pulmonary tumors showed features indistinguishable from hepatocellular carcinoma and were diffusely positive for Hepatocyte Paraffin 1.

Keywords:
Adenocarcinoma; Hepatoid carcinoma; Hepatocellular carcinoma; Non-small cell carcinoma,

Authorship

Yu Miyama

The University of Tokyo, Graduate School of Medicine, Department of Pathology. Tokyo, Japan.The University of TokyoJapanTokyo, JapanThe University of Tokyo, Graduate School of Medicine, Department of Pathology. Tokyo, Japan.

https://orcid.org/0000-0001-5901-6961

Takeshi Fujii

Toranomon Hospital Kajigaya, Department of Pathology. Kawasaki, Japan.Toranomon Hospital KajigayaJapanKawasaki, JapanToranomon Hospital Kajigaya, Department of Pathology. Kawasaki, Japan.

https://orcid.org/0000-0001-7237-1183

Kyoko Murase

Toranomon Hospital Kajigaya, Department of Respiratory Medicine. Kawasaki, Japan.Toranomon Hospital KajigayaJapanKawasaki, JapanToranomon Hospital Kajigaya, Department of Respiratory Medicine. Kawasaki, Japan.

https://orcid.org/0000-0002-0418-843X

Hisashi Takaya

https://orcid.org/0000-0002-0116-4184

Fukuo Kondo

Teikyo University Hospital, Department of Pathology. Tokyo, Japan.Teikyo University HospitalJapanTokyo, JapanTeikyo University Hospital, Department of Pathology. Tokyo, Japan.

https://orcid.org/0000-0003-0392-3997

Authors’ contributions: Miyama Y made the autopsy and wrote the manuscript. Murase K treated the patient and provided an accurate statement about the patient’s clinical course. Takaya H made the literature review as a Clinician. Fujii T made the literature review as a Pathologist. Kondo F was responsible for the conception and design of the work and its critical revision. The authors obtained informed consent signed by the deceased next of kin authorizing the data publication.

The authors retain informed consent signed by the deceased next of kin authorizing the data publication.

Conflict of interest: None

Correspondence Yu Miyama Department of Pathology - Graduate School of Medicine - The University of Tokyo 7-3-1 Hongo – Bunkyo-ku/Tokyo 113-0033 – Japan Phone: +81 (3) 5841-3341 / Fax: +81 (3) 3815-8379 miyamay-pat@h.u-tokyo.ac.jp

SCIMAGO INSTITUTIONS RANKINGS

Toranomon Hospital Kajigaya, Department of Pathology. Kawasaki, Japan.Toranomon Hospital KajigayaJapanKawasaki, JapanToranomon Hospital Kajigaya, Department of Pathology. Kawasaki, Japan.

Teikyo University Hospital, Department of Pathology. Tokyo, Japan.Teikyo University HospitalJapanTokyo, JapanTeikyo University Hospital, Department of Pathology. Tokyo, Japan.

Figures

Figures (8)

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Figure 1
Chest CT at the initial diagnosis, showing in A – A poorly-defined 6 cm tumor with surrounding atelectasis, and pleural effusion, in the right lower pulmonary lobe, and a contralateral metastasis (arrowhead); B – Note the absence of hepatic involvement.

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Figure 2
Photomicrographs of the needle biopsy. A – The neoplastic cells forming solid structures with central necrosis. (H&E, Bar: 100 μm); B – The neoplastic cells with abundant eosinophilic cytoplasm and round nuclei (H&E, Bar: 50 μm)

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Figure 3
Chest CT obtained at 6 months after diagnosis showing in A – increasing size of the tumors volumes of both lungs increased. B – A whole-body CT scan revealed a nodule (arrow) in the liver.

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Figure 4
Gross findings of the cut surfaces of the lungs. A – The right lung is shown. Note the thickened pleura and area of atelectasis. There are multiple tumors (maximum diameter: 7.5 cm) in the bronchi and pleura; B – An enlarged view of the lesion depicted in Figure 4A; C – Gross view of the left lung. Note the presence of several tumors (maximum diameter: 2.5 cm); D – An enlarged view of the area surrounded by a rectangle in Figure 4C is shown.

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Figure 5
Photomicrographs of the right lung tumor. A – The neoplastic cells are in solid nests and trabecular structures with central necrosis. (H&E, Bar: 100 μm); B – The neoplastic cells have abundant eosinophilic cytoplasm and round nuclei. Several mitotic figures are seen (arrowheads) (H&E, Bar: 50 μm), C – The neoplastic cells also form acinar structures, (H&E, Bar: 50 μm); D – Acidic mucin production is in the acinar lumina. Periodic acid Schiff and Alcian blue staining were performed (Bar: 50 μm).

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Figure 6
Immunohistochemical reactions of the right lung tumor. A – The neoplastic cells were positive for Hep Par-1 (Bar: 50 μm); B – The nuclei of the neoplastic cells were negative for TTF-1. However, these cells displayed cytoplasmic TTF-1 staining (Bar: 50 μm); C – The neoplastic cells were negative for AFP (Bar: 50 μm); D – The neoplastic cells were negative for Arginase-1 (Bar: 50 μm).

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Figure 7
Gross findings of the cut surface of the liver. A – Nodular lesion in the right lobe of the liver. The nodule was well circumscribed and did not exhibit capsulation; B – Note a similar nodule in the left hepatic lobe.

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Figure 8
Photomicrographs of the hepatic tumor. A – The transition area between the uninvolved hepatic tissue (left side) and hepatoid adenocarcinoma (right side) (H&E, Bar: 200 μm); B – The neoplastic cells are displayed in nested structures mimicking a hepatocellular carcinoma (H&E, Bar: 50 μm).

Figure 1 Chest CT at the initial diagnosis, showing in A – A poorly-defined 6 cm tumor with surrounding atelectasis, and pleural effusion, in the right lower pulmonary lobe, and a contralateral metastasis (arrowhead); B – Note the absence of hepatic involvement.

Figure 2 Photomicrographs of the needle biopsy. A – The neoplastic cells forming solid structures with central necrosis. (H&E, Bar: 100 μm); B – The neoplastic cells with abundant eosinophilic cytoplasm and round nuclei (H&E, Bar: 50 μm)

Figure 3 Chest CT obtained at 6 months after diagnosis showing in A – increasing size of the tumors volumes of both lungs increased. B – A whole-body CT scan revealed a nodule (arrow) in the liver.

Figure 4 Gross findings of the cut surfaces of the lungs. A – The right lung is shown. Note the thickened pleura and area of atelectasis. There are multiple tumors (maximum diameter: 7.5 cm) in the bronchi and pleura; B – An enlarged view of the lesion depicted in Figure 4A; C – Gross view of the left lung. Note the presence of several tumors (maximum diameter: 2.5 cm); D – An enlarged view of the area surrounded by a rectangle in Figure 4C is shown.

Figure 5 Photomicrographs of the right lung tumor. A – The neoplastic cells are in solid nests and trabecular structures with central necrosis. (H&E, Bar: 100 μm); B – The neoplastic cells have abundant eosinophilic cytoplasm and round nuclei. Several mitotic figures are seen (arrowheads) (H&E, Bar: 50 μm), C – The neoplastic cells also form acinar structures, (H&E, Bar: 50 μm); D – Acidic mucin production is in the acinar lumina. Periodic acid Schiff and Alcian blue staining were performed (Bar: 50 μm).

Figure 6 Immunohistochemical reactions of the right lung tumor. A – The neoplastic cells were positive for Hep Par-1 (Bar: 50 μm); B – The nuclei of the neoplastic cells were negative for TTF-1. However, these cells displayed cytoplasmic TTF-1 staining (Bar: 50 μm); C – The neoplastic cells were negative for AFP (Bar: 50 μm); D – The neoplastic cells were negative for Arginase-1 (Bar: 50 μm).

Figure 7 Gross findings of the cut surface of the liver. A – Nodular lesion in the right lobe of the liver. The nodule was well circumscribed and did not exhibit capsulation; B – Note a similar nodule in the left hepatic lobe.

Figure 8 Photomicrographs of the hepatic tumor. A – The transition area between the uninvolved hepatic tissue (left side) and hepatoid adenocarcinoma (right side) (H&E, Bar: 200 μm); B – The neoplastic cells are displayed in nested structures mimicking a hepatocellular carcinoma (H&E, Bar: 50 μm).

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Hepatoid adenocarcinoma of the lung mimicking metastatic hepatocellular carcinoma

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[1] Authors’ contributions: Miyama Y made the autopsy and wrote the manuscript. Murase K treated the patient and provided an accurate statement about the patient’s clinical course. Takaya H made the literature review as a Clinician. Fujii T made the literature review as a Pathologist. Kondo F was responsible for the conception and design of the work and its critical revision. The authors obtained informed consent signed by the deceased next of kin authorizing the data publication.