Hepatoid adenocarcinoma: A challenging Dx in patients with G
The present case has been published in BMJ. A 50-year-old man with a history of iron-deficiency anaemia and fatty liver disease presented to the emergency department complaining of black tarry stools with associated weakness and shortness of breath for 1 week.

At presentation, contrast-enhanced CT revealed multiple hypervascular masses in the abdomen and pelvis with the largest lesion located in the right lower quadrant, abutting the right psoas muscle (figure 1). Laboratory evaluation demonstrated a haemoglobin level of 5.5 g/dL (normal, 13.5–17.5 g/dL).

Upper endoscopy showed a mass, which was making an extrinsic impression into the stomach. Colonoscopy was unremarkable for abnormalities. Endoscopic ultrasound-guided fine-needle aspiration (FNA) of the lesion adjacent to the stomach was performed using a 22-gauge needle.

The FNA was positive for metastatic carcinoma with hepatic features. Furthermore, capsule endoscopy identified blood clots surrounding the multiple, small intestinal masses. These lesions were subsequently identified as the metastatic hepatoid adenocarcinoma (HAC) based on the histopathological findings.

Learning points
• Hepatoid adenocarcinoma (HAC) is a rare extrahepatic adenocarcinoma that morphologically and immunophenotypically mimics hepatocellular carcinoma. To our research, this is the eighth documented case of primary peritoneal HAC in the literature.

• Differentiating primary peritoneal HAC from other tumours is a challenge and is also critical.

• Due to rarity and heterogeneity of primary peritoneal HAC, no standard treatment exists.

• The standard diagnostic and therapeutic algorithms are particularly warranted for these tumours, especially in patients with unusual initial presentations related to the gastrointestinal bleeding.

Read in detail here: http://casereports.bmj.com/content/2018/bcr-2018-226938.full