title: Hepatoid adenocarcinoma of the colon in a patient with inflammatory bowel disease.
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.
authors.affiliation: Yuanyuan Chen, Eric M Yoshida, Division of Gastroenterology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Yuanyuan Chen, Eric M Yoshida, Division of Gastroenterology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
authors.forename: David F
authors.initials: DF
authors.lastname: Schaeffer
authors.affiliation: Yuanyuan Chen, Eric M Yoshida, Division of Gastroenterology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology* / Q000556:secondary / Q000628:therapy; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D001706:Biopsy; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000175:diagnosis; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007081:Ileostomy; D007582:Jejunostomy; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000556:secondary; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil
keywords: Alpha-fetoprotein; Colon cancer; Hepatoid adenocarcinoma; Inflammatory bowel disease; Metastasis; Primary sclerosing cholangitis; Recurrence; Ulcerative colitis