Alpha-fetoprotein-high-producing hepatoid adenocarcinoma of the stomach:A case report and litera-ture review / 实用肿瘤学杂志

Hepatoid adenocarcinoma of the stomach ( HAS) belongs to one of the rare cases in gastric cancer types ,which has extremely high malignant degree and poor prognosis .Lymph node metastasis and liver me-tastasis are common in HAS.In this article,we reported alpha-fetoprotein-high-producing hepatoid adenocar-cinoma of the stomach(HAS),and reviewed the related literature at home and abroad in order to improve clinical physicians understanding of these diseases and treatment experience .

AFP-producing gastric cancer and hepatoid gastric cancer / 中华肿瘤杂志

AFP-producing gastric cancer(AFPGC) and hepatoid adenocarcinoma of the stomach (HAS) are two special subtypes of gastric cancer. There are both correlation and difference between them. AFPGC is usually identified as primary gastric cancer with serum AFP level more than 20 ng/ml or showed AFP positive staining by immunohistochemistry. The diagnosis of HAS is mainly dependent on the pathological character of hepatocellular carcinoma-like differentiation of gastric cancer. The morbidity of AFPGC and HAS are rather low, especially the incidence of HAS is about 1%. The prognoses of these two subtypes are poorer than that of common gastric adenocarcinoma, due to a high incidence rate of liver metastasis and lymph node metastasis. With the development of next-generation sequencing and other genomic technologies, gastric cancers, including these two rare subtypes, are now being investigated in more detail at the molecular level. Treatment remains the biggest challenge, early diagnosis and radical resection can dramatically improve patients′prognosis. Monitoring serum AFP and abdominal imaging examination during follow-up is important for early detection of liver metastasis. In combination with local treatment methods such as transarterial chemoembolization and radiofrequency ablation of liver may further extend patients′survival time. Targeted therapy owes a great potential value in the future.

Hepatoid Adenocarcinoma of the Stomach Misconceived as a Primary Liver Tumor

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. The tumor was characterized by high serum alpha-fetoprotein (AFP) levels. A 73-year-old male patient was admitted to the hospital with abdominal pain. Gastrofiberscopy revealed a gastric tumor occupying the antrum and pylorus. Radical subtotal gastrectomy was done and the result of biopsy was poorly differentiated adenocarcima of stomach and stage 3B. At postoperation 8 month, AFP was elevated and liver mass was detected on CT. Right extended hepatectomy was done under the impression of primary liver tumor. But, the biopsy revealed metastatic hepatoid adenocarcinoma of the stomach. Re-examination of the resected stomach was done and the result was hepatoid adenocarcinoma of the stomach. Two months later, after the hepatic resection, multiple metastases developed. This type of tumor has frequent early liver metastasis and poor prognosis. Therefore, early diagnosis and more careful investigation for liver metastasis are recommended.

Hepatoid Adenocarcinoma of the Stomach: A Clinical Analysis of Fourteen Cases

PURPOSE: Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. Their incidence is rare, and they usually produce large amounts of alpha-fetoprotein (AFP). They have a specific pathologic feature, frequently occur together with liver metastasis and have a poor prognosis. This study was undertaken to understand the characteristics of clinical feature. METHODS: Fourteen hepatoid adenocarcinoma cases of gastric cancer were analyzed among 3243 patients who were treated for gastric cancer at our center between Jan 1996 and August 2003 (0.43%). RESULTS: There were 13 males and one female patient, with a median age of 59 years, ranging from 40 to 75. Ten tumors were located in the antrum, 2 in the body and 2 in the fundus. The size of the tumors varied from 2.3 to 11.0 cm. Direct invasions to adjacent organ were (4 to the pancreas and 1 to the colon). Four cases had visible lymph node enlargement at the time of the operation, ranging (from 3.5 to 6.0 cm). During the operation, 2 patients were found to have metastasis to the liver, 1 to the retroperitoneum, and 1 was positive on peritoneal washing cytology. The preoperative serum CEA levels were elevated in 7 patients, and 5 in 8 patients showed very high preoperative serum AFP levels ranging from 34.5 to 3724 ng/ml. All patients underwent a gastrectomy, and a hepatectomy in cases of liver metastasis. Pathological staging revealed one in stage Ib, four in stage II, one in stage IIIb and eight in stage IV. Immunohistochemical stainings was performed on all patients. Ten cases were positive for AFP. During follow up, eight patients died due to tumor (mean survival time: 10.6 months). Five had liver metastasis and 3 a recurrence in the peritoneum. The 6 remaining patients are still alive. CONCLUSION: 1. Hepatoid adenocarcinomas are rare and preoperatively diagnosis. The preoperative diagnostic methods of pathological consideration and preoperative serum AFP levels of all gastric cancer patients are recommended. 2. Hepatoid adenocarcinomas of the stomach have frequent and early postoperative liver metastasis and a poor prognosis, not only in advanced gastric caner but also in early cancer. Therefore, a possibly curative resection and more aggressive study for liver metastasis are recommended as being mandatory, and more sufficient treatment for these cases should be investigated.

Hepatoid adenocarcinoma of the stomach: report of 3 cases and review of the literature in recent ten years / 中国癌症杂志

Purpose:To analyze the clinical manifestations, so the diagnosis of hepatoid adenocarcinoma of the stomach (HAS) may be made and treatment instituted as early as possible. Methods:A total of 65 cases of HAS reported in the literature in recent ten years reviewed.Results:①Clinical symptoms and signs: The incidence of HAS in male was higher than that in female (6.2:1).Upper abdominal discomfort and physical signs of mass bclow the sternum were most commonly seen.②Diagnosis: The serum content of AFP were discombfort high level with a positive rate of 66.7%(22/33). The positive rate of AFP expression with immunohistochemical method was 94.5%(52/55).The percentage of liver metastasis detected by US B or CT was 20.5%(9/44) preoperation, and mostly seen at the gastric sinus was ahout 63.3%(19/30). The final diagnosis of HAS depends on gastrocopy and pathology. ③Treatment and Prognosis: The possibility of radical operation(D 2 ) is only 17.9%(5/28). The death ratio within one year was 56.3%(18/32).Conclusions: HAS is primarily a gastric carcinoma. The serum AFP levels are help fulin the diagnosis and differential diagnosis of HAS. The diagnostic evidence of HAS is dependant on its specific forms. The prognosis is often poor because of frequent liver metastasis.