Jae Hoon Lee, et al. metabolic mass in the portocaval area, suggesting meta- static lymphadenopathy (Fig. 1B). Right hemihepatec- tomy with lymph node dissection was performed (Fig. 1C). The liver and lymph nodes of portocaval and inferior vena cava showed metastatic adenocarcinoma with hep- atoid features (Fig. 2A). In immunohistochemical study, AFP and alpha-1 antitrypsin were positive in the hepatoid area and negative in the glandular area (Fig. 2B, C). Hepatocyte Paraffin 1 (Hep Par1), cytokeratin 7, and cyto- keratin 20 were all negative. Slides from the previously op- erated gallbladder mass were reviewed to clarify the pri- mary origin of metastatic HAC. Our results, combined with immunohistochemical analysis of previous operated gallbladder mass (Fig. 3), confirmed gallbladder as the tu- mor origin. The patient received adjuvant chemotherapy (Gemcita- bine and 5-fluorouracil) and radiotherapy (4,500 cGy, 5 weeks). However, 4 months after hepatectomy, he was re- admitted with abdominal distension from ascites. Follow- up CT showed multiple metastases in the left lobe of liver and superior mesenteric vein thrombosis with extension into the portal vein. He died one month after readmission. DISCUSSION HAC is a special type of extrahepatic adenocarcinoma, with a striking morphologic similarity to hepatocellular carcinoma (HCC). HAC occurs predominantly in older patients, and is characterized by a very aggressive course, and a poor prognosis. Its biological behavior reflects ex- tensive hematogenous metastasis to the liver, and the ear- ly and frequent involvement of lymph nodes is an im- portant feature [8]. Fig. 2. (A) Highly pleomorphic cells arranged in a rosettoid, nested, or trabecular pattern with relatively clear cytoplasm, enlarged nuclei, and prominent nucleoli. Numerous hyaline globules are noted in the intercellular or intracellular areas (H&E ×200). Immunohistochemical staining for alpha-fetoprotein (B) and alpha1-antitrypsin (C) showed strongly positive in the hepatoid area of the liver (×200). 442 thesurgery.or.kr