Hepatoid adenocarcinoma in the urinary bladder. Unusual localization of a newly recognized tumor type

• Published in: Cancer Vol. 73; no. 7; pp. 1919 - 1925
• Main Authors: Sinard, John, Macleay, Lachlan, Melamed, Jonathan
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.04.1994; Wiley-Liss
• Subjects: Adenocarcinoma - classification; Adenocarcinoma - pathology; Aged; alpha 1-Antitrypsin - analysis; alpha-Fetoproteins - analysis; alpha‐fetoprotein; Antigens, Neoplasm - analysis; Biological and medical sciences; canalicular; carcinoembryonic antigen; Carcinoembryonic Antigen - analysis; Carcinoma, Endometrioid - pathology; Carcinoma, Transitional Cell - pathology; Cell Nucleus - ultrastructure; classification; Cytoplasm - ultrastructure; Female; hepatoid adenocarcinoma; Humans; Keratins - analysis; Liver - pathology; Medical sciences; Membrane Glycoproteins - analysis; Mucin-1; Nephrology. Urinary tract diseases; Tumors of the urinary system; Ureteral Neoplasms - pathology; urinary Bladder; Urinary Bladder Neoplasms - classification; Urinary Bladder Neoplasms - pathology; Urinary tract. Prostate gland; Uterine Neoplasms - pathology; Adenocarcinoma; Case study; Human; Immunohistochemistry; Pathology; Urinary system disease; Urinary bladder; Malignant tumor; Urinary tract disease
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19940401)73:7<1919::AID-CNCR2820730724>3.0.CO;2-L

A tumor mass resected from the anterior bladder wall of a 68‐year‐old woman displayed unusual histologic features: sheets of hepatoid cells merging focally with a secondary glandular pattern of adenocarcinoma. Intracytoplasmic hyaline globules and bile production within the solid areas supported the impression of hepatocytic differentiation. Immunoreactivity for alpha‐fetoprotein (AFP) and alpha‐1‐antitrypsin and a striking canalicular immunostaining pattern for carcinoembryonic antigen and epithelial membrane antigen all indicate hepatocellular differentiation within this bladder tumor. This represents a case of a hepatoid adenocarcinoma located in the urinary bladder. The use of the term “hepatoid” in the literature is reviewed and the reported cases are grouped into two distinct categories of tumors: (1) germ cell tumors with focal hepatoid areas and (2) true hepatoid adenocarcinomas that meet histologic and immuno‐histochemical criteria for hepatocellular differentiation. AFP‐producing tumors without any other feature of hepatocellular differentiation should not be considered as hepatoid tumors. This classification of hepatoid tumors is likely to be important in elucidating the histogenesis and clinicopathologic features of these unusual neoplasms.