Extremely high alpha-fetoprotein-producing adrenal hepatoid adenocarcinoma.

Tawasapon Thambamroong, Naiyarat Prasongsook, Kantang Satayasoontorn, Siriwimon Saichaemchan

BMJ case reports 2021 Jul 12

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Hepatoid adenocarcinoma (HAC) is a rare tumour that produces an alpha-fetoprotein (AFP) mimicking hepatocellular carcinoma (HCC). Adrenal HAC is exceedingly rare. Here we report extremely high AFP-producing adrenal HAC, the first case in Thailand. A 47-year-old man presented with left flank pain and weight loss for 2 months. A palpably huge left flank mass was observed on physical examination. CT revealed a 7 cm enhanced mass involving the left adrenal gland and multiple contrast-enhanced hypodense masses in both liver lobes. The largest was a 3.7 cm at liver segment-VII without cirrhotic background, with an AFP level of 321 495 ng/mL. Both adrenal and liver biopsies were performed. This patient received a diagnosis of advanced adrenal HAC. Unfortunately, the tumour progressed, causing massive upper gastrointestinal bleeding and death. Adrenal HAC is challenging to diagnose, which multifocal HCC, pheochromocytoma and adrenocortical carcinoma should be excluded. Surgical resection is preferred among resectable patients. However, no systemic therapy has been standardised. © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Tawasapon Thambamroong, Naiyarat Prasongsook, Kantang Satayasoontorn, Siriwimon Saichaemchan. Extremely high alpha-fetoprotein-producing adrenal hepatoid adenocarcinoma. BMJ case reports. 2021 Jul 12;14(7)