Hepatoid carcinoma of the pancreas combined with serous cystadenoma: a case report and review of the literature

Pancreatic hepatoid carcinoma (HC) is an extremely uncommon neoplasm of pancreas thatresembles hepatocellular carcinoma (HCC). We report a case of incidentally detected pancreatic HCcombined with a serous microcystic cystadenoma, in a 47-year-old man, while he was being evaluatedfor renal calculi. Contrast enhanced computed tomography (CECT) of abdomen revealed a lesion withmild heterogeneous enhancement in the tail of pancreas and another proximal lesion having moderateenhancement, and a calculus in the neck of gallbladder. Serum chromogranin, carcinoembryonic antigen(CEA) and CA 19-9 levels were within normal limits. He underwent laparoscopic distal pancreatectomy withsplenectomy and cholecystectomy. Pathologically the distal tumor was encapsulated and characterized byeosinophilic cytoplasm, vesicular nucleus with prominent nucleolus and intranuclear eosinophilic inclusions.The cells were arranged in trabecular pattern separated by sinusoids. Canalicular and intercellular bile plugswere seen. On immunohistochemistry tumor cells were positive for hepatocyte specific antigen and weakly positive for alpha fetoprotein (AFP). The proximal tumor showed features of serous microcystic adenoma.Based on these findings, the case was diagnosed as hepatoid tumor of pancreas combined with serousmicrocystic cystadenoma. Post operative AFP was 1.75 IU/mL. The patient is on follow up for the last eightmonths and there is no evidence of recurrence.