PMC6817769_01
Lung mass and enlarged lymph nodes. Chest CT shows the mass in the right superior lobe of the lung invading the nearby pleura (A-C) and enlarged lymph nodes (D). PET/CT 3 months later reveals enlargement of the lung mass, and abnormal uptake of lung mass and lymph nodes (E-G). Hematoxylin-eosin staining shows the hepatoid adenocarcinoma feature (H). Immunohistochemical studies reveal the expression of HepPar-1 and absence of AFP (I, J). H&E x40, HepPar-1 x20, AFP x20.
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A chest CT showed a 6.0 x 4.6 cm2 mass in the right superior lobe of the lung with mild heterogeneous enhancement invading the nearby pleura and enlarged lymph nodes in the right hilum and mediastinum (Figure 1A-D). After 3 months of treatment, an FDG-PET/CT scan revealed enlargement of the lung mass (8.1 x 5.8 cm2), no significant change in the lymph nodes in the right hilum and mediastinum, and enlarged submandibular lymph nodes with abnormal uptake (maximum standard uptake value of 13.2) (Figure 1E-G). Histopathologic examination of the mass in the right superior lobe of the lung revealed pulmonary adenocarcinoma with hepatoid features (Figure 1H).
Gingival and lymph-node metastases of pulmonary hepatoid adenocarcinoma. MRI shows a gingival mass with destruction of the mandible (A), and enlargement of the right submandibular lymph node (B). H&E staining shows the hepatoid adenocarcinoma feature (C). HepPar-1 staining was positive (D). MRI shows necrosis of the gingival mass without significant decrease in size, and greater lymph nodes in the neck after chemoradiotherapy (E, F). H&E x40, HepPar-1 x20.
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MRI of the neck showed a mass on the right lower gingiva with destruction of the mandible, and enlarged right submandibular lymph nodes (Figure 2A and B). Histopathologic examination of the mass on the right lower gingiva revealed an HAC metastasis (Figure 2C). MRI showed necrosis of the gingival mass without any significant decrease in size, while the lymph metastasis in the neck worsened (Figure 2E and F).