Non-α-fetoprotein-producing adrenal hepatoid adenocarcinoma: A case report and literature review.

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

Medicine

authors

Lin J,Cao Y,Yu L,Lin L

doi

10.1097/MD.0000000000012336

subject

Has Abstract

pub_date

2018-09-01 00:00:00

pages

e12336

issue

39

eissn

0025-7974

issn

1536-5964

pii

00005792-201809280-00032

journal_volume

97

pub_type

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