Alpha-fetoprotein-producing hepatoid adenocarcinoma of the gallbladder : a case report and review of literature

Hepatoid adenocarcinoma (HAC) is an uncommon type of malignancy in extrahepatic tissues. It was named for its histopathological resemblance of hepatocellular carcinoma, the most common form of liver cancer. The occurrence of HAC in the gallbladder is very low, and tumours that produce alpha-fetoprotein are even rarer. Clinically, it is usually diagnosed histopathologically; and the prognosis is generally poor, largely due to its metastasis to the liver and peripheral lymph nodes. Currently, laparoscopic cholecystectomy combined with lymphadenectomy is the major therapeutic strategy for this type of cancer. Postoperative chemotherapy and periodic review are required to reduce the chance of recurrence. Because of the low occurrence of HAC in the gallbladder, our knowledge and therapeutic options against this malignancy are limited. Understanding the characteristics of the progression of this malignancy would be beneficial to its diagnosis and treatment in future clinical practice. In this study, we report a case of HAC of the gallbladder in a 55-year-old male, who presented a significant increase of alpha-fetoprotein and a marginal elevation of carcinoembryonic antigen in serum. The patient underwent laparoscopic cholecystectomy and lymphadenectomy, followed by sorafenib administration. As a result, no recurrence was found during the follow-up period, and the patient maintained a general quality of life.