Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12657
Revised: April 12, 2014
Accepted: May 12, 2014
Published online: September 21, 2014
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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.
Core tip: This is the first reported case of a synchronous presentation of typical and hepatoid adenocarcinomata of the colon in a patient with long-standing ulcerative colitis and primary sclerosing cholangitis. This report addresses the clinical importance of probing for hepatoid adenocarcinomata in patients with increased serum alpha-fetoprotein levels in the absence of hepatocellular carcinoma.