Abstract
Primary hepatoid adenocarcinoma(HAC)of the uterus is a particular tumour that bears high similarity to hepatocellular carcinoma histologically,and may easily be misdiagnosed because it is rare if you don't remember it.In this report,we describe two cases of alpha-fetoprotein(AFP)-produ-cing HAC of the uterus.Case 1 was a 69-year-old postmenopausal woman who was presented to the hospi-tal for a medical examination.Positron emission computed tomography and gross examination revealed an invasive mass on the cervix.Microscopically,the tumor cells grew in trabecularand and solid patterns with heteromorphic nuclei and abundant eosinophilic cytoplasm,and were stained positively for AFP,spalt-like transcription factor 4(SALL-4),cytokeratin 7(CK7),hepatocyte paraffin 1(Hep Par 1),Glypican 3 and p1 6.The paired box protein 8(PAX8),Vimentin,CK20,estrogen receptor(ER),progesterone receptor(PR)were negative.P53 protein was strongly diffuse staining,suggesting the pos-sibility of potential mutation in the TP53 gene.The final pathological diagnosis was cervical HAC com-bined with endocervical adenocarcinoma and endocervical adenocarcinoma in situ.To the best of our knowledge,however,it is the third case confined to the uterine cervix reported in Chinese and English literature.Case 2 was a 57-year-old postmenopausal woman with abnormal vaginal bleeding for 4 months.Biopsy was considered as poorly differentiated endometrial carcinoma.Finally,pure HAC in endometrium was diagnosed in postoperative specimens.The histological features and immunohistochemical results were similar to those in case 1.A total abdominal hysterectomy,bilateral salpingo-oophorectomy,pelvic lymphadenectomy and pelvic adhesiolysis were carried out in both cases.Serum levels of AFP were in-creased remarkably in both cases pre-operation and decreased after surgery,which was proved to be closely related to tumor progression,recurrence,and also the patient's response to treatment.The diag-nosis of HAC is mainly based on the histological features,and immunohistochemistry is a good assistant,but it needs to be differentiated from metastatic hepatocellular carcinoma(HCC),germ cell tumors,and yolk sac tumor.Following surgery,both patients received chemotherapy,and case 1 also received radio-therapy,and has been free of disease for 25 months and 5 months,respectively.
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