Abstract:
RATIONALE:Adrenal hepatoid adenocarcinoma typically secretes alpha-fetoprotein (AFP). Here, we report a case of non-AFP-producing adrenal hepatoid adenocarcinoma. Next-generation sequencing (NGS) was conducted to identify gene mutations. PATIENT CONCERNS:A 64-year-old man presented with mild back pain and unexplained weight loss for 3 months. DIAGNOSES:Contrast-enhanced magnetic resonance imaging (MRI) showed a mass (9.9 × 9.7 × 9.1 mm) above the upper pole of the left kidney. The left renal artery and vein were compressed. The tumor was positive for CK8/18, CK19, CK7, hepatocyte marker (Hepatocyte), and Hep Par 1, but negative for AFP. Plasma AFP was 2.75 ng/mL (normal range: 0-7 ng/mL). NGS revealed mutations of the following genes: ATM, CDKN2A, EGFR, STK11, TP53, BIM, and MLH1. A diagnosis of adrenal hepatoid adenocarcinoma was established. INTERVENTIONS:The treatment included 4 cycles of the mFOLFOX6 regimen (oxaliplatin, leucovorin, and fluorouracil), transcatheter arterial chemoembolization, and apatinib. OUTCOMES:The patient died 9 months after the diagnosis. LESSONS:This case highlights the importance of thorough clinical, radiological, and immunohistochemical investigation for suspected adrenal hepatoid adenocarcinoma. Metastasis from other primary tumors should be ruled out. Furthermore, AFP is not necessarily elevated in adrenal hepatoid adenocarcinoma. NGS could be helpful in establishing the diagnosis and selecting treatments.
journal_name
Medicine (Baltimore)journal_title
Medicineauthors
Lin J,Cao Y,Yu L,Lin Ldoi
10.1097/MD.0000000000012336subject
Has Abstractpub_date
2018-09-01 00:00:00pages
e12336issue
39eissn
0025-7974issn
1536-5964pii
00005792-201809280-00032journal_volume
97pub_type
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