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Extremely high alpha-fetoprotein-producing adrenal hepatoid adenocarcinoma
  1. Tawasapon Thambamroong1,
  2. Naiyarat Prasongsook1,
  3. Kantang Satayasoontorn2 and
  4. Siriwimon Saichaemchan1
  1. 1Medical Oncology Division, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
  2. 2Department of Pathology, Phramongkutklao Hospital, Bangkok, Thailand
  1. Correspondence to Dr Tawasapon Thambamroong; t.thambamroong{at}; Assistant Professor Siriwimon Saichaemchan; xray5401{at}


Hepatoid adenocarcinoma (HAC) is a rare tumour that produces an alpha-fetoprotein (AFP) mimicking hepatocellular carcinoma (HCC). Adrenal HAC is exceedingly rare. Here we report extremely high AFP-producing adrenal HAC, the first case in Thailand. A 47-year-old man presented with left flank pain and weight loss for 2 months. A palpably huge left flank mass was observed on physical examination. CT revealed a 7 cm enhanced mass involving the left adrenal gland and multiple contrast-enhanced hypodense masses in both liver lobes. The largest was a 3.7 cm at liver segment-VII without cirrhotic background, with an AFP level of 321 495 ng/mL. Both adrenal and liver biopsies were performed. This patient received a diagnosis of advanced adrenal HAC. Unfortunately, the tumour progressed, causing massive upper gastrointestinal bleeding and death. Adrenal HAC is challenging to diagnose, which multifocal HCC, pheochromocytoma and adrenocortical carcinoma should be excluded. Surgical resection is preferred among resectable patients. However, no systemic therapy has been standardised.

  • urological cancer
  • endocrine cancer
  • hepatic cancer
  • pathology

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  • NP and SS contributed equally.

  • Contributors Manuscript writing, review, diagnosis and treatment—TT. Manuscript writing, diagnosis and treatment—NP and SS. Manuscript writing and dagnosis—KS. Final approval—TT, NP and SS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.