In 2014, Haninger et al. modified the Ishikura diagnostic criteria for HAL, stating that 1) the tumor may be pure Hepatoid adenocarcinoma or contain components of typical acinar adenocarcinoma, papillary adenocarcinoma, signet ring cell carcinoma, or neuroendocrine carcinoma, and 2) AFP expression is not essential for diagnosis if other hepatic differentiation markers are expressed [11]. This evidence concerns the gene AFP and papillary adenocarcinoma.