ReviewQuantitative imaging in medicine and surgery2026
Imaging of pancreatic hepatoid adenocarcinoma: a scoping review.
Review in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pancreatic hepatoid adenocarcinoma (PHAC) is a rare pancreatic malignancy characterized by hepatoid differentiation. It is often associated with elevated serum alpha-fetoprotein (AFP) levels. This scoping review sought to investigate PHAC imaging to improve diagnostic accuracy. Methods: A comprehensive literature search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted to retrieve relevant articles published up to November 20, 2025. The clinicopathological characteristics, imaging features, and outcomes of patients with PHAC were systematically extracted from eligible studies and analyzed. Statistical analyses were conducted using the Kaplan-Meier method to estimate survival and Cox regression models to identify prognostic factors. Results: A total of 58 patients with PHAC from 54 studies were included in the analysis. PHAC predominantly affected the elderly male patients and often presented with non-specific symptoms or signs of biliary obstruction. Approximately 62.8% of the patients exhibited elevated serum AFP levels, which may serve as a critical biomarker for monitoring postoperative recurrence. Radiologically, these tumors typically originated from the pancreatic body and tail, and appeared as heterogeneous solid masses with a median size of 6 cm. Main pancreatic duct dilation was uncommon. Two primary enhancement patterns were observed: "wash-in/wash-out" and hypovascular patterns. Arterial hypoenhancement was significantly associated with poor histological differentiation (P=0.020) and elevated AFP levels (P=0.001). Metastases occurred in 41.4% of the cases, primarily to the liver (66.7%) and lymph nodes (62.5%). Surgical resection was identified as an independent prognostic factor and was associated with improved survival compared with non-surgical treatment [5-year overall survival (OS) rate: 56.8% Conclusions: PHAC typically presents as a well-defined, heterogeneous solid mass, often accompanied by local invasion. Two major enhancement patterns were observed. Surgical resection was the only independent prognostic factor identified; however, novel therapeutic strategies require validation in larger cohorts.
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