Hepatoid Adenocarcinoma Presenting as Pancreatitis

Abstract

Hepatoid adenocarcinoma (HAC) is an uncommon and aggressive type of adenocarcinoma, typically affecting the middle-aged and elderly. The morphological features of the HAC resemble hepatocellular carcinoma. Presenting symptoms may include upper abdominal pain, hematemesis, back pain, and palpable abdominal mass. HAC has no proven therapy, and the prognosis is extremely poor. Early surgical removal with chemotherapy remains the standard of care. We describe one of the youngest patients in the literature with HAC who presented with acute pancreatitis. The diagnostic workup was confused by diffuse lymphadenopathy and elevated β-human chorionic gonadotropin making lymphoma and germ cell tumor likely possibilities until immunohistochemistry confirmed the diagnosis.

Figure 1.

Magnetic resonance cholangiopancreatography showing diffuse lymphadenopathy with mild intrahepatic biliary ductal dilatation.

Figure 2.

Abdominal computed tomography showing inflammation around the pancreatic head and the duodenum with retroperitoneal and peritoneal lymphadenopathy.

Figure 3.

Nonbleeding cratered gastric ulcer (10 mm at the largest dimension) with no stigmata of bleeding on the lesser curvature of the stomach.

Figure 4.

(A and B) Histology of hepatoid adenocarcinoma from gastric, duodenal, and bile duct brushing. Note the mixture of glandular cells and cells with hepatoid differentiation.