A Rare Tumor in a Patient with Hepatic Hydatic Cyst: Adrenal Hepatoid Adenocarcinoma

Hepatoid adenocarcinoma (HAC) is a very rare type of extrahepatic adenocarcinoma which has a clinicopathologic and morphologic similarity to hepatocellular carcinoma (HCC). Although it is not common, it can be seen in organs other than the liver. The correct diagnosis can be a challenge because of its clinically similarity to HCC and the diagnosis is usually achieved by pathological examination following the surgery. We present a 48-year-old woman who was following with the diagnosis of stage 5 hepatic hydatic cyst. In her routine blood examinations, her alpha feta protein level was found higher than normal and her abdominal computed tomography and magnetic resonance findings did not reveal any pathological findings rather than hepatic hydatic cysts. There was a high activity of FDG on PET CT in the hepatic region so we performed a right lateral hepatectomy to the patient and final pathology was adrenal hepatoid adenocarcinoma. In this paper we aimed to present a rare case of hepatoid carcinoma of the adrenal gland. 1. Introduction Hepatoid adenocarcinoma (HAC) is a very rare variant of extrahepatic adenocarcinoma [1]. HAC can originate from different organs [2–10]. The stomach is most common site of this tumor. HAC is usually found incidentally in the routine examinations while the patient is followed up for another disease [1]. We aimed to present an asymptomatic case that was found to have a hepatic tumour which had a final pathology as extrahepatic hepatoid adenocarcinoma, while she was following up with stage 5 hepatic hydatic cyst. 2. Case Report We present a 48 years old woman who was following up with the diagnosis of stage 5 hydatic cyst. The serological test is performed for hydatic cyst (indirect hemagglutination test) and the result was 1/640. In her routine examinations alpha feta protein was 3900？n/mL. Abdominal Computed Tomography revealed ？mm stage 5 Hydatic cyst in the right hepatic lobe and a ？mm in the left hepatic lobe (Figure 1(a)). There was not another pathology detected in abdominal magnetic resonance imaging. In FDG18 Positron Emition Tomography there was a ？cm mass in the liver. It was near the right lobe cyst and it was reached to the diaphragmatic crura. This mass revealed a high activity of FDG (suvmax 80) (Figure 1(b)). The patient was operated with the diagnosis of hepatic mass. There was a hydatic cyst in the 6-7th segments of the liver and on the posterior of the cyst there was a ？cm mass which was invaded to diaphragmatic crura. Segment 6-7 hepatectomy and diaphragmatic resection were performed. The adrenal glands and