Clinical Characteristics Of Hepatoid Adenocarcinoma Of The Lung:Two Case Report And Literature Review

Objective:To analyse the clinicopathological feature of hepatoid adenocarcinoma of the lung in order to expand the understanding of the disease.Methods:Retrospective analysis of he First Affiliated Hospital of Guangxi Medical University 2 cases of hepatoid adenocarcinoma of the lung patients with clinical manifestations,laboratory tests,imaging and pathology data,and review the relevant literature,to explore the clinical characteristics of HALResults:(1).Case 1 patient was a 50-year-old man,past long history of smoking,no history of liver disease,the main symptoms were cough,hoarseness,chest pain.Serum AFP and liver function were normal.Lung CT showed the left upper lobe of the occupying lesions,bronchoscopic brush smear showed cancer cells,percutaneous lung biopsy Pathological results suggested hepatoid adenocarcinoma of the lung,AFP expression was negative.Liver CT and ultrasound were normal.Patients didn't accept chemotherapy and survived for 4months after discharge.Case 2 patient was a 58-year-old man,past a history of smoking,the main symptoms were cough,sputum and chest pain.Serum AFP and liver function were normal.Pulmonary CT showed left lower lobe large sheet density increased shadow,PET / CT examination demonstrated metabolic increased shadow,lung tissue pathological diagnosis confirmed hepatoid adenocarcinoma of the lung,AFP expression was positive.Liver CT and ultrasound were normal.Patients didn't accept chemotherapy and was still alive after discharge.(2).The results of literature review:From the PUBMED and otherdatabases retrieval from 1990 to December,2016 cases with HAL at home and abroad,a total of 40 articles were retrieved and pathological diagnosis confirmed HAL,among them,92.5%(37/40)were males,and the average age of onset was59.4 years old.The lesions were found in the upper leaves(31/40),29 cases reported clinical symptoms,24.1% were asymptomatic(7/29)and 75.8% were symptoms,of the main respiratory symptoms were cough,sputum,hemoptysis and difficulty breathing.A total of 26 cases of radiographic findings were single nodules,round or lobulated,part of the burr,near the hilar and close to the chest wall.Most patients of serum AFP were elevated and immunohistochemical AFP expression were positive.Histopathological similar to hepatocellular carcinoma,composed of hepatoid differentiation and adenocarcinoma.Treatment methods include surgery,chemotherapy,radiotherapy.Conclusions:1.HAL is a rare etiology of lung nodules,mostly in the elderly incidence,is male incidence,often has a history of smoking and no history of liver disease.2.HAL main respiratory symptoms are cough,sputum and hemoptysis,some are asymptomatic,Lesion occurs in the upper leaf,showing a larger diameter single nodules,lesions can be enhanced,PET / CT examination demonstrated metabolic increased shadow.3.The diagnosis of HAL depends on the pathology of lung tissue has the morphological characteristics of hepatocellular carcinoma,excepting lung metastasis.4.AFP expression in HAL cells is positive,serum AFP levels can be increased.