Intraoperative frozen section diagnosis of primary alpha-fetoprotein–positive hepatoid adenocarcinoma of the gallbladder: A case report

Figure 1 Multimodal positron emission tomography/computed tomography images of the patient. A: Soft tissue mass in the gallbladder with abnormally increased metabolism; B: Enlarged lymph nodes in the retroperitoneum with abnormally increased metabolism; C: Distribution of high-uptake lesions in the gallbladder fossa and retroperitoneum.

Figure 2 Gallbladder specimens. A: Gallbladder specimen and gross view after dissection of the bottom of the gallbladder; B: Gross view of the 13 groups of lymph nodes submitted for examination.

Figure 3 Routine pathological sections of hepatoid adenocarcinoma. A: Solid and cord-like hepatoid differentiation pattern of tumor cells; B: Ring-like cancer cell morphology; C: Moderately differentiated glandular and papillary structures; D: Perineural invasion (tumor cells encircling a nerve bundle) and microvascular invasion (tumor embolus within a small blood vessel). A-D: Hematoxylin and eosin staining, × 400.

Figure 4 Immunohistochemical results of gallbladder hepatoid adenocarcinoma. A: Spalt-like transcription factor 4; B: Glypican-3; C: Alpha-fetoprotein; D: Arginase-1; E: Cytokeratin 7.