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Objectives <p>Hepatoid adenocarcinoma (HAC) is a rare malignant neoplasm arising in extrahepatic tissues and organs, and its prompt and correct diagnosis remains clinically challenging. <sup>18</sup>F-FDG PET/CT is widely utilized for the evaluation of various tumor types, relevant data regarding its performance in HAC remain limited. The present study aimed to summarize the ¹⁸F-FDG PET/CT imaging features of HAC and to assess its clinical impact on patient management.</p> Methods <p>A total of 66 patients with pathologically confirmed HAC underwent 71 <sup>18</sup>F-FDG PET/CT examinations. These examinations included 44 for pre-treatment staging, 16 for postoperative surveillance, and 11 for assessment of treatment response following non-surgical therapy. PET-derived metabolic parameters (SUVmax, MTV, TLG), lesion location, lymph node metastasis status, and corresponding alterations in clinical management were retrospectively collected and analyzed.</p> Results <p>Among 44 patients with initial HAC, the stomach was the most common primary tumor site (26/44, 59.1%). All primary tumors, with the exception of those of ovarian origin, exhibited increased FDG uptake, with a median SUVmax of 9.25. Elevated serum alpha-fetoprotein (AFP) levels were observed in 79.5% (35/44) of patients at initial diagnosis. A majority of patients (24/44, 54.5%) presented with distant metastases at the time of initial diagnosis, where the liver was the most common metastatic site (16/44, 36.4%), followed by distant lymph nodes (8/44, 18.2%) and bone (5/44, 11.4%). Notably, 50.0% (2/4) of T1-stage tumors had already developed distant metastases. The findings of <sup>18</sup>F-FDG PET/CT led to changes in patient diagnosis and treatment strategies: 36.36% (16/44) of newly diagnosed patients and 43.75% (7/16) of postoperative patients had their clinical treatment strategies adjusted. In addition, no significant correlations were found between PET metabolic parameters and serum levels of AFP or carcinoembryonic antigen (CEA) (all <i>P</i> &gt; 0.05).</p> Conclusion <p><sup>18</sup>F-FDG PET/CT facilitates accurate staging of hepatoid adenocarcinoma by detecting occult metastases and guiding clinical management in initial diagnosis and postoperative surveillance. The most frequent primary site is the stomach, with the liver being the main metastatic organ. Importantly, <sup>18</sup>F-FDG PET/CT findings significantly influences clinical management for patients with HAC prior to and after treatment without correlation to AFP or CEA levels.</p>

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The role of 18F-FDG PET/CT in the clinical evaluation of hepatoid adenocarcinoma

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Lili Lin,
  • Wenxin Wang,
  • Jing Yan,
  • Yafei Zhang,
  • Shuye Yang,
  • Xue Wen,
  • Kui Zhao,
  • Jun Zhang,
  • Xinhui Su

摘要

Objectives

Hepatoid adenocarcinoma (HAC) is a rare malignant neoplasm arising in extrahepatic tissues and organs, and its prompt and correct diagnosis remains clinically challenging. 18F-FDG PET/CT is widely utilized for the evaluation of various tumor types, relevant data regarding its performance in HAC remain limited. The present study aimed to summarize the ¹⁸F-FDG PET/CT imaging features of HAC and to assess its clinical impact on patient management.

Methods

A total of 66 patients with pathologically confirmed HAC underwent 71 18F-FDG PET/CT examinations. These examinations included 44 for pre-treatment staging, 16 for postoperative surveillance, and 11 for assessment of treatment response following non-surgical therapy. PET-derived metabolic parameters (SUVmax, MTV, TLG), lesion location, lymph node metastasis status, and corresponding alterations in clinical management were retrospectively collected and analyzed.

Results

Among 44 patients with initial HAC, the stomach was the most common primary tumor site (26/44, 59.1%). All primary tumors, with the exception of those of ovarian origin, exhibited increased FDG uptake, with a median SUVmax of 9.25. Elevated serum alpha-fetoprotein (AFP) levels were observed in 79.5% (35/44) of patients at initial diagnosis. A majority of patients (24/44, 54.5%) presented with distant metastases at the time of initial diagnosis, where the liver was the most common metastatic site (16/44, 36.4%), followed by distant lymph nodes (8/44, 18.2%) and bone (5/44, 11.4%). Notably, 50.0% (2/4) of T1-stage tumors had already developed distant metastases. The findings of 18F-FDG PET/CT led to changes in patient diagnosis and treatment strategies: 36.36% (16/44) of newly diagnosed patients and 43.75% (7/16) of postoperative patients had their clinical treatment strategies adjusted. In addition, no significant correlations were found between PET metabolic parameters and serum levels of AFP or carcinoembryonic antigen (CEA) (all P > 0.05).

Conclusion

18F-FDG PET/CT facilitates accurate staging of hepatoid adenocarcinoma by detecting occult metastases and guiding clinical management in initial diagnosis and postoperative surveillance. The most frequent primary site is the stomach, with the liver being the main metastatic organ. Importantly, 18F-FDG PET/CT findings significantly influences clinical management for patients with HAC prior to and after treatment without correlation to AFP or CEA levels.