{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T03:20:27Z","timestamp":1768620027303,"version":"3.49.0"},"reference-count":22,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,12]],"date-time":"2022-06-12T00:00:00Z","timestamp":1654992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>We present the 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography\/computed tomography (PET\/CT) findings in a 57-year-old woman with post-menopausal bleeding diagnosed with hepatoid adenocarcinoma (HAC) with a primary tumour in the uterine corpus and a highly elevated level of serum-\u03b1-fetoprotein (S-AFP) at presentation. HAC is a variant of adenocarcinoma with hepatic differentiation representing a heterogeneous group of neoplasms that morphologically and immunphenotypically resemble hepatocellular carcinoma (HCC) but are of extrahepatic origin. Microscopically, they are usually poorly differentiated adenocarcinomas proliferating in solid sheets or in a trabecular or cord-like arrangement. Primary uterine HAC is exceedingly rare with a general poor prognosis, and data is sparse and limited to case reports, making the clinical management challenging. Various primary anatomical sites have been reported in the literature, with the stomach being the most common primary site. 18F-FDG PET\/CT plays an important role in staging and follow-up in many gynecological malignancies including uterine corpus cancer. To the best of our knowledge, this is the first report describing a primary uterine hepatoid adenocarcinoma with metastases to bone, vagina and lymph nodes on 18F-FDG PET\/CT. By utilizing the ability of PET to detect early metabolic changes prior to visible structural changes on conventional imaging, this case illustrates a potential role of 18FDG-PET\/CT in the staging of primary endometrial HAC by depicting distant metastasis that is not readily identifiable on CT alone.<\/jats:p>","DOI":"10.3390\/diagnostics12061447","type":"journal-article","created":{"date-parts":[[2022,6,12]],"date-time":"2022-06-12T09:26:48Z","timestamp":1655026008000},"page":"1447","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Disseminated Primary Uterine Hepatoid Adenocarcinoma with \u03b1-Fetoprotein Production Demonstrated on 18F-FDG PET\/CT"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5540-8933","authenticated-orcid":false,"given":"Danijela","family":"Dejanovic","sequence":"first","affiliation":[{"name":"Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Boennelycke","sequence":"additional","affiliation":[{"name":"Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annemarie Gjelstrup","family":"Amtoft","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte Birk","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Copenhagen University Hospital, 2730 Herlev, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Wetterstroem","sequence":"additional","affiliation":[{"name":"Department of Imaging and Radiology, Copenhagen University Hospital\u2014North Zealand, 3400 Hil-leroed, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Loft","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trine Jakobi","family":"Noettrup","sequence":"additional","affiliation":[{"name":"Department of Oncology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1046\/j.1440-1827.2000.01124.x","article-title":"Alpha-fetoprotein producing uterine corpus carcinoma: A hepatoid adenocarcinoma of the endometrium","volume":"50","author":"Toyoda","year":"2000","journal-title":"Pathol. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1136\/jcp.49.5.420","article-title":"Alpha-fetoprotein production by a hepatoid adenocarcinoma of the uterus","volume":"49","author":"Yamamoto","year":"1996","journal-title":"J. Clin. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1002\/1097-0142(19850815)56:4<840::AID-CNCR2820560423>3.0.CO;2-E","article-title":"An AFP-producing gastric carcinoma with features of hepatic differentiation. A case report","volume":"56","author":"Ishikura","year":"1985","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1159\/000305717","article-title":"Hepatoid adenocarcinoma\u2014Review of the literature illustrated by a rare case originating in the peritoneal cavity","volume":"33","author":"Metzgeroth","year":"2010","journal-title":"Onkologie"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7649","DOI":"10.2147\/OTT.S216501","article-title":"AFP-producing hepatoid adenocarcinoma (HAC) of peritoneum and omentum: A case report and literature review","volume":"12","author":"Zou","year":"2019","journal-title":"OncoTargets Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.prp.2011.02.010","article-title":"Primary hepatoid adenocarcinoma of the uterine corpus: A case report with immunohistochemical study for expression of liver-enriched nuclear factors","volume":"207","author":"Ishibashi","year":"2011","journal-title":"Pathol. Res. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/00004347-199607000-00012","article-title":"Hepatoid Adenocarcinoma of the Endometrium Associated with Alpha-Fetoprotein Production","volume":"15","author":"Hoshida","year":"1996","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1111\/j.1349-7006.1996.tb00267.x","article-title":"Biochemical characterization of alpha-fetoprotein and other serum proteins produced by a uterine endometrial adenocarcinoma","volume":"87","author":"Koyama","year":"1996","journal-title":"Jpn. J. Cancer Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/0016-5085(78)90141-5","article-title":"\u03b1-Fetoprotein (AFP) in benign liver disease: Evidence that normal liver regeneration does not induce AFP synthesis","volume":"74","author":"Alpert","year":"1978","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1002\/1097-0142(19930915)72:6<1827::AID-CNCR2820720606>3.0.CO;2-8","article-title":"Hepatoid adenocarcinoma of the stomach. A clinicopathologic and immunohistochemical analysis","volume":"72","author":"Nagai","year":"1993","journal-title":"Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1046\/j.1525-1438.1995.05040314.x","article-title":"Ovarian hepatoid carcinoma without staining for alpha-fetoprotein in the primary site","volume":"5","author":"Nishida","year":"1995","journal-title":"Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"bcr0220125830","DOI":"10.1136\/bcr.02.2012.5830","article-title":"\u03b1-fetoprotein produced by endometrioid adenocarcinoma of uterus","volume":"2012","author":"Akhavan","year":"2012","journal-title":"BMJ Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3892\/ol_00000043","article-title":"alpha-fetoprotein-producing endometrial adenocarcinoma without an obvious hepatoid component","volume":"1","author":"Kodama","year":"2010","journal-title":"Oncol. Lett."},{"key":"ref_14","first-page":"399","article-title":"Alpha-fetoprotein-producing papillary adenocarcinoma originating from a uterine body. A case report","volume":"41","author":"Kubo","year":"1991","journal-title":"Acta Pathol. Jpn."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/01.pgp.0000225843.21503.30","article-title":"Alpha-fetoprotein-producing serous carcinoma of the uterus metastasizing to the ovaries, mimicking primary ovarian yolk sac tumor: A case report and review of the literature","volume":"26","author":"Tran","year":"2007","journal-title":"Int. J. Gynecol. Pathol. Off. J. Int. Soc. Gynecol. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1136\/jcp.49.4.349","article-title":"Alpha-fetoprotein production by a malignant mixed mullerian tumour of the uterus","volume":"49","author":"Phillips","year":"1996","journal-title":"J. Clin. Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1046\/j.1440-1827.2003.01467.x","article-title":"Hepatoid carcinoma of the uterus that collided with carcinosarcoma","volume":"53","author":"Takahashi","year":"2003","journal-title":"Pathol. Int."},{"key":"ref_18","first-page":"1442","article-title":"A case of alpha-fetoprotein-producing adenocarcinoma of the endometrium with a hepatoid component as a potential source for alpha-fetoprotein in a postmenopausal woman","volume":"16","author":"Takeuchi","year":"2006","journal-title":"Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1111\/jog.12237","article-title":"Endometrial hepatoid adenocarcinoma: A rare cause of elevated serum alpha-fetoprotein","volume":"40","author":"Wu","year":"2014","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e425","DOI":"10.1097\/RLU.0000000000002538","article-title":"A Rare Case of Primary Endometrial Hepatoid Adenocarcinoma on 18F-FDG PET\/CT","volume":"44","author":"Yin","year":"2019","journal-title":"Clin. Nucl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1006\/gyno.2001.6383","article-title":"An \u03b1-Fetoprotein-Producing Hepatoid Adenocarcinoma of the Endometrium","volume":"83","author":"Adams","year":"2001","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/0090-8258(88)90238-7","article-title":"Alpha-fetoprotein producing endometrial adenocarcinoma: Report of a case","volume":"29","author":"Matsukuma","year":"1988","journal-title":"Gynecol. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/6\/1447\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:28:32Z","timestamp":1760138912000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/6\/1447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,12]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["diagnostics12061447"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12061447","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,12]]}}}