{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:02:26Z","timestamp":1756425746502,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,17]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>Hepatoid adenocarcinoma (HAC) is a rare tumour that produces an alpha-fetoprotein (AFP) mimicking hepatocellular carcinoma (HCC). Adrenal HAC is exceedingly rare. Here we report extremely high AFP-producing adrenal HAC, the first case in Thailand. A 47-year-old man presented with left flank pain and weight loss for 2\u2009months. A palpably huge left flank mass was observed on physical examination. CT revealed a 7\u2009cm enhanced mass involving the left adrenal gland and multiple contrast-enhanced hypodense masses in both liver lobes. The largest was a 3.7\u2009cm at liver segment-VII without cirrhotic background, with an AFP level of 321\u2009495\u2009ng\/mL. Both adrenal and liver biopsies were performed. This patient received a diagnosis of advanced adrenal HAC. Unfortunately, the tumour progressed, causing massive upper gastrointestinal bleeding and death. Adrenal HAC is challenging to diagnose, which multifocal HCC, pheochromocytoma and adrenocortical carcinoma should be excluded. Surgical resection is preferred among resectable patients. However, no systemic therapy has been standardised.<\/jats:p>","DOI":"10.1136\/bcr-2020-239830","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T12:32:30Z","timestamp":1626093150000},"page":"e239830","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Extremely high alpha-fetoprotein-producing adrenal hepatoid adenocarcinoma"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6066-4253","authenticated-orcid":false,"given":"Tawasapon","family":"Thambamroong","sequence":"first","affiliation":[{"name":"Medical Oncology Division, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naiyarat","family":"Prasongsook","sequence":"additional","affiliation":[{"name":"Medical Oncology Division, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kantang","family":"Satayasoontorn","sequence":"additional","affiliation":[{"name":"Department of Pathology, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siriwimon","family":"Saichaemchan","sequence":"additional","affiliation":[{"name":"Medical Oncology Division, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"2025082723384505000_14.7.e239830.1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i3.321"},{"key":"2025082723384505000_14.7.e239830.2","first-page":"4247","article-title":"A rare case of hepatoid adenocarcinoma of the adrenal gland","volume":"9","author":"Liu","year":"2016","journal-title":"Int J Clin Exp Pathol"},{"key":"2025082723384505000_14.7.e239830.3","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000012336","article-title":"Non-\u03b1-fetoprotein-producing adrenal hepatoid adenocarcinoma: a case report and literature review","volume":"97","author":"Lin","year":"2018","journal-title":"Medicine"},{"key":"2025082723384505000_14.7.e239830.4","first-page":"511","article-title":"An adrenal Hepatoid adenocarcinoma with left renal vein thrombosis extending into the inferior vena cava","volume":"16","author":"Deng","year":"2019","journal-title":"Urol J"},{"key":"2025082723384505000_14.7.e239830.5","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29913"},{"key":"2025082723384505000_14.7.e239830.6","first-page":"411","article-title":"[Adrenal hepatoid carcinoma producing alpha-fetoprotein: a case report]","volume":"40","author":"Yoshioka","year":"1994","journal-title":"Hinyokika Kiyo"},{"key":"2025082723384505000_14.7.e239830.7","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6604016"},{"key":"2025082723384505000_14.7.e239830.8","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.jamcollsurg.2013.07.402","article-title":"Determination of clonal origin of recurrent hepatocellular carcinoma for personalized therapy and outcomes evaluation: a new strategy for hepatic surgery","volume":"217","author":"Wang","year":"2013","journal-title":"J Am Coll Surg"},{"key":"2025082723384505000_14.7.e239830.9","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200310000-00002"},{"key":"2025082723384505000_14.7.e239830.10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/gastro\/gov021","article-title":"Liver metastasis from hepatoid adenocarcinoma of the esophagus mimicking hepatocellular carcinoma","volume":"5","author":"Kashani","year":"2017","journal-title":"Gastroenterol Rep"},{"key":"2025082723384505000_14.7.e239830.11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/824574","article-title":"A rare tumor in a patient with hepatic hydatic cyst: adrenal hepatoid adenocarcinoma","volume":"2014","author":"Malya","year":"2014","journal-title":"Case Rep Med"},{"key":"2025082723384505000_14.7.e239830.12","first-page":"527","article-title":"One case of left adrenal hepatoid adenocarcinoma","volume":"6","author":"Zhang","year":"2016","journal-title":"Chin J Endocrinol"},{"key":"2025082723384505000_14.7.e239830.13","unstructured":"Yi L , Jiangyang L , Xiaohong W . 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Diagn Pathol J 2009."},{"key":"2025082723384505000_14.7.e239830.14","first-page":"194","volume-title":"Clinical and pathological observation of adrenal Hepatoid adenocarcinoma practical cancer journal","volume":"02","author":"Jing","year":"2015"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239830","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:38:56Z","timestamp":1756363136000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239830"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":14,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,12]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bcr-2020-239830"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239830","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}