Hepatoid Adenocarcinoma: A Wolf in Hepatocellular Carcinoma's Clothing

Hepatoid adenocarcinoma (HAC) is a rare malignancy that may mimic hepatocellular carcinoma (HCC) given its hepatoid histologic appearance and production of alpha fetoprotein. Clinical management and prognosis of HAC varies considerably from HCC. We present two cases of metastatic HAC in a cirrhotic liver diagnosed after biopsy and histopathological evaluation. The cases underscore the importance of recognizing the limitations of diagnostic imaging and pursuing a biopsy where there is diagnostic uncertainty.