Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2014; 20(35): 12657-12661
Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12657
Hepatoid adenocarcinoma of the colon in a patient with inflammatory bowel disease
Yuanyuan Chen, David F Schaeffer, Eric M Yoshida
Yuanyuan Chen, Eric M Yoshida, Division of Gastroenterology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
David F Schaeffer, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
Author contributions: Chen Y drafted the article; Schaeffer DF obtained the pathologic background and data; Schaeffer DF and Yoshida EM critically revised the manuscript for intellectual content and approved the final version.
Correspondence to: Eric M Yoshida, MD, MHSc, FRCPC, Professor, Department Head, Division of Gastroenterology, University of British Columbia, 5th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada. eric.yoshida@vch.ca
Telephone: +1-604-8755371 Fax: +1-604-8755447
Received: January 10, 2014
Revised: April 12, 2014
Accepted: May 12, 2014
Published online: September 21, 2014
Abstract

A case is presented of a 36-year-old male with primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD) and two synchronous stage 1 adenocarcinomata of the colon, who was initially treated with a subtotal colectomy with ileostomy. One year later, the patient presented with extensive intra-abdominal lymphadenopathy and peritoneal carcinomatosis, as well as a markedly elevated serum level of alpha-fetoprotein (AFP). Fine needle aspiration biopsy of a porta hepatis lymph node revealed a metastatic hepatoid adenocarcinoma. Subsequent review of the previous colectomy specimen showed that one of the previously identified adenocarcinomata had features suggestive of a hepatoid colonic adenocarcinoma. The patient was subsequently treated with a cytotoxic regimen of FOLFOX (oxaliplatin, leucovorin, 5-fluorouracil) and bevacizumab, with stable results being achieved after six months. This case presents the first known report of PSC-IBD associated with synchronous typical and hepatoid adenocarcinomata of the colon and highlights the importance of considering hepatoid adenocarcinoma as a differential diagnosis in patients with an increasing serum AFP level.

Keywords: Hepatoid adenocarcinoma, Inflammatory bowel disease, Colon cancer, Alpha-fetoprotein, Ulcerative colitis, Primary sclerosing cholangitis, Recurrence, Metastasis

Core tip: This is the first reported case of a synchronous presentation of typical and hepatoid adenocarcinomata of the colon in a patient with long-standing ulcerative colitis and primary sclerosing cholangitis. This report addresses the clinical importance of probing for hepatoid adenocarcinomata in patients with increased serum alpha-fetoprotein levels in the absence of hepatocellular carcinoma.