ABSTRACT
Objective:To review the clinicopathological characteristics and analyze the prognostic factors of hepatoid adenocarcinoma of stomach(HAS).Methods:From August 2012 to June 2017,30 patients with HAS were diagnosed in Daycare of Peking University Cancer Hospital.Clinicopathological data and follow-up information of these patients were retrospectively collected and analyzed.Re-sults:The median age of these 30 patients was 58 years at diagnosis,with a male-to-female ratio of 2.75:1.Twenty-nine patients were confirmed to have lymph node metastases and 7 patients had distant metastases.Ten patients died because of the cancer within the follow-up period.The 1-and 3-year survival rates were 60% and 52%,respectively.Cox multivariate regression revealed that elevated serum CA199 levels,higher lymph node staging,not having undergone radical surgery,and stronger immunohistochemical(IHC)stain-ing intensity of alpha fetoprotein(AFP)were independent poor prognostic factors.Conclusions:Elevated serum CA199 levels,lymph node staging,and IHC staining intensity of AFP are verified in this study as independent risk factors of poor outcome in HAS patients. Early detection and diagnosis of the disease may improve the clinical prognosis.Multidisciplinary team discussions are important in making therapy decisions and radical surgery should be performed whenever possible.
ABSTRACT
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.
ABSTRACT
Hepatoid adenocarcinoma (HAC) of the gallbladder is a variant of extrahepatic adenocarcinoma with hepatic differentiation.With similar clinicopathological presentation,the main differential diagnoses are hepatocellular carcinoma (HCC) and gallbladder carcinoma (GBC).At present,HAC of the gallbladder have only been reported in a few researches.This article will summarize comprehensive researches on the histological origin,clinical characteristics,histopathological and immunohistochemical characteristics,differential diagnosis,therapy and prognosis of HAC of the gallbladder.
ABSTRACT
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 .
ABSTRACT
Objective To study the clinicopathological features and prognosis of Gastric hepatoid adenocarcinoma (GHA) and aims to guide future clinical practice.Method We retrospectively studied the clinical data of 25 patients with pathologically confirmed GHA who were admitted to our hospital from January 2003 to December 2015.Results There were 19 males and 6 females.The average age was 61.2 years.The clinical manifestations were non-specific.Pathologically,majority of GHA presented with ulcerative type,poor differentiation and extensive vascular cancerous embolus.Preoperative liver metastases were found in 12 patients,and postoperative liver metastases in 15 patients.Conclusions GHA is a special primary gastric adenocarcinoma which possesses both hepatocellular carcinoma-like and adenocarcinoma-like histology.GHA is characterized by a significantly elevated serum AFP and early hepatic metastasis.GHA is therefore often misdiagnosed as primary hepatocellular carcinoma.The main treatment option remains to be surgical resection,and the prognosis is poor.
ABSTRACT
Gastric hepatoid adenocarcinoma (GHA) is a rare but important sub-type of gastric adenocarcinoma characterized by high serum α-fetoprotein,early lymphatic and hepatic metastasis,and poor prognosis.Clinically,the presentation could be atypical,liver neoplasm could be the initial finding.With similar clinicopathological presentation as hepatocellular carcinoma (HCC),prompt and correct diagnosis can be a challenge,especially in endemic areas with a high incidence of HCC.Once diagnosed,surgical removal remains the treatment of choice.This review focus on advancement on the biological,histological and immunohistological features,and the clinicopathological presentation of GHA.
ABSTRACT
Gastric hepatoid adenocarcinoma is a rare adenocarcinoma that develops in the stomach. The prognosis of gastric hepatoid adenocarcinoma is poorer than that of ordinary gastric adenocarcinoma. Here, we report the first case of human epidermal growth factor receptor 2 (HER2)-positive gastric hepatoid adenocarcinoma in Korea. A 57-year-old male presented with abdominal distension and underwent endoscopic gastric biopsy and percutaneous core needle liver biopsy. The pathological findings were consistent with HER2-positive gastric hepatoid adenocarcinoma. He received six cycles of chemotherapy with cisplatin-capecitabine plus trastuzumab, which is a HER2 targeted agent. After chemotherapy, a follow-up abdominal computed tomography scan showed a partial tumor response. This case emphasizes the importance of using trastuzumab in a patient with HER2-positive gastric hepatoid adenocarcinoma.
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma , Biopsy , Drug Therapy , Follow-Up Studies , Korea , Liver , Needles , Prognosis , ErbB Receptors , StomachABSTRACT
Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer that histologically resembles hepatocellular carcinoma and is characterized by large amounts of alpha fetoprotein in the serum. The prognosis of HAS is poor compared to that of primary gastric cancer with five-year survival rates of 9% and 44%, respectively. Here, we report five patients diagnosed with HAS. Our experience suggests that an advanced stage of HAS has an extremely poor prognosis, but early detection and radical surgery can help improve the prognosis of the disease.
Subject(s)
Humans , Adenocarcinoma , alpha-Fetoproteins , Carcinoma, Hepatocellular , Prognosis , Stomach , Stomach Neoplasms , Survival RateABSTRACT
Hepatoid adenocarcinoma of the stomach is a rare form of gastric carcinoma with specifi c clinicopathological features and extremely poor prognosis. Here, we report a case of a 60-year-old male patient who presented in the outpatient department with pain abdomen and constitutional symptoms. Radiological examination revealed a growth involving the antrum of the stomach while the liver and spleen were normal. The serum alpha fetoproteins were 6590 ng/ml. The patient underwent a partial gastrectomy and microscopic examination of the growth showed two types of histological patterns. Majority of the tumor displayed hepatoid differentiation with adenocarcinomatous foci. Periodic acid Schiff positive intracytoplasmic hyaline globules were seen. The tumor was immunohistochemically positive for alpha fetoprotein. The patient underwent radical gastrectomy, received chemotherapy and has been on follow-up for the past 12 months. Though known to be an aggressive neoplasm early diagnosis of hepatoid adenocarcinoma can help improve the prognosis of the disease.
ABSTRACT
A 50-year-old male patient presented with pain abdomen of 6 months duration. Computed tomography scan revealed a large mass in the stomach occluding the lumen. Histopathology revealed a triple composite tumor comprising of tubular adenocarcinoma arising on a background of high-grade dysplasia, hepatoid adenocarcinoma (positive for Hep Par-1 and alpha fetoprotein) and large cell neuroendocrine carcinoma (positive for synaptophysin and chromogranin) with nodal metastasis.Triple composite tumors are distinctly rare with few reports in literature.
ABSTRACT
Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-year-old man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alpha-fetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymph-node metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP.
Subject(s)
Aged , Humans , Male , Adenocarcinoma/diagnosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Camptothecin/analogs & derivatives , Carcinoma, Hepatocellular/diagnosis , Chemoembolization, Therapeutic , Chemotherapy, Adjuvant , Fluorouracil/therapeutic use , Gastroscopy , Leucovorin/therapeutic use , Liver Neoplasms/diagnosis , Lymph Nodes/surgery , Lymphatic Metastasis , Recurrence , Silicates/therapeutic use , Stomach Neoplasms/diagnosis , Titanium/therapeutic use , Tomography, X-Ray Computed , alpha-Fetoproteins/analysisABSTRACT
No abstract available.
Subject(s)
Aged , Humans , Male , Adenocarcinoma/diagnosis , Carcinoma, Hepatocellular/diagnosis , Immunohistochemistry , Liver Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , alpha-Fetoproteins/analysisABSTRACT
Gastric hepatoid adenocarcinoma is a special type of gastric carcinoma, which produces AFP. We report a case of an metastatic gastric hepatoid adenocarcinoma mistaken for primary hepatocellular carcinoma (HCC). A 72 year-old woman was transferred to our hospital for treatment of the hepatic mass. She underwent subtotal gastrectomy for gastric cancer 2 years ago. A year ago, she was diagnosed with hepatic mass and treated with transhepatic chemoembolization under the suspicion of primary HCC in other hospital. The hepatic mass looked like primary HCC on CT, and serum AFP was elevated to 18,735 IU/mL. We did the transhepatic mass biopsy and compared it to the histology of the previous gastric cancer. The results of immunohistochemical staining between them was coincident, and so it was diagnosed as a hepatic metastasis of gastric hepatoid adenocarcinoma.
Subject(s)
Aged , Humans , Male , Adenocarcinoma/diagnosis , Carcinoma, Hepatocellular/diagnosis , Embolization, Therapeutic , Endoscopy, Gastrointestinal , Homeodomain Proteins/metabolism , Keratin-20/metabolism , Keratin-7/metabolism , Liver Neoplasms/diagnosis , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , alpha-Fetoproteins/analysisABSTRACT
Gastric hepatoid adenocarcinoma is a special type of gastric carcinoma, which produces AFP. We report a case of an metastatic gastric hepatoid adenocarcinoma mistaken for primary hepatocellular carcinoma (HCC). A 72 year-old woman was transferred to our hospital for treatment of the hepatic mass. She underwent subtotal gastrectomy for gastric cancer 2 years ago. A year ago, she was diagnosed with hepatic mass and treated with transhepatic chemoembolization under the suspicion of primary HCC in other hospital. The hepatic mass looked like primary HCC on CT, and serum AFP was elevated to 18,735 IU/mL. We did the transhepatic mass biopsy and compared it to the histology of the previous gastric cancer. The results of immunohistochemical staining between them was coincident, and so it was diagnosed as a hepatic metastasis of gastric hepatoid adenocarcinoma.
Subject(s)
Aged , Humans , Male , Adenocarcinoma/diagnosis , Carcinoma, Hepatocellular/diagnosis , Embolization, Therapeutic , Endoscopy, Gastrointestinal , Homeodomain Proteins/metabolism , Keratin-20/metabolism , Keratin-7/metabolism , Liver Neoplasms/diagnosis , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , alpha-Fetoproteins/analysisABSTRACT
Hepatoid adenocarcinoma (HAC) is a tumor with aberrant hepatocellular differentiation that occurs in extrahepatic organs. HAC of the gallbladder is rare, and cases of alpha-fetoprotein production are extremely rare. A 61-year-old man was diagnosed with gallbladder adenocarcinoma after laparoscopic cholecystectomy. A radical operation including resection of liver bed and lymph node dissection was performed, and no tumor cell was found. However, at postoperative 19 months, he showed lymphadenopathy of the portocaval area and tumor thrombi in the right portal vein with high levels of serum alpha-fetoprotein. After right hemihepatectomy and portahepatis lymph node dissection was performed, he was diagnosed with metastatic HAC. On reviewing the gallbladder specimen, the tumor finally demonstrated HAC as the primary origin. Despite adjuvant therapy, the patient died from multiple liver metastasis 26 months after cholecystectomy. Although HAC of the gallbladder is a very rare malignancy, awareness of its existence is critical to avoid misdiagnosis.
Subject(s)
Humans , Middle Aged , Adenocarcinoma , alpha-Fetoproteins , Cholecystectomy , Cholecystectomy, Laparoscopic , Diagnostic Errors , Gallbladder , Liver , Lymph Node Excision , Lymphatic Diseases , Neoplasm Metastasis , Portal VeinABSTRACT
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.
Subject(s)
Aged , Humans , Male , Abdominal Pain , Adenocarcinoma , alpha-Fetoproteins , Biopsy , Early Diagnosis , Gastrectomy , Hepatectomy , Liver , Neoplasm Metastasis , Prognosis , Pylorus , StomachABSTRACT
We report herein a case of hepatoid adenocarcinoma of the stomach with liver metastasis. Gastric carcinoma generally presents as adenocarcinoma and rarely shows a hepatoid pattern, which can produce alpha-fetoprotein (AFP). The stomach is one of the common sites at which hepatoid adenocarcinoma has been detected. A 75-year-old female patient was admitted to the hospital with a symptom of epigastric discomfort. Gastrofibroscopy revealed a large tumor occupying the greater curvature of the stomach body. The level of serum AFP was markedly increased. Abdominal computed tomography revealed multiple liver masses. Biopsy samples of the gastric lesion and liver masses finally confirmed her case as hepatoid adenocarcinoma in the stomach with liver metastasis. The AFP-producing gastric carcinoma needs special attention because it often presents with early liver metastasis and has a poor prognosis.
Subject(s)
Aged , Female , Humans , Adenocarcinoma/diagnosis , Gastroscopy , Liver Neoplasms/diagnosis , Lymphatic Metastasis , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , alpha-Fetoproteins/metabolismABSTRACT
A hepatoid adenocarcinoma of stomach, a subtype of gastric cancr, is characterized by a histologic resemblance to a hepatocellular carcinoma and alpha-feto protein production. Another feature is early metastasis to the liver and lymph nodes, thus revealing a poor prognosis. We report a case of a hepatoid adenocarcinoma of the stomach with liver metastasis. A 52-year-old male visited our hospital with a chief complaint of indigestion. Gastroscopic examination showed a Borrmann type-II lesion on the lesser curvature of the antrum. The CT scan showed a suspected advanced gastric cancer with liver metastasis. The serum AFP level was 123 ng/ml. A radical subtotal gastrectomy and a right hemihepatectomy were performed simultaneously. Pathologic examination confirmed the lesion to be confined to the submucosa. The gastric lesion was a hepatoid adenocarcinoma, and the hepatic lesion was a metastatic adenocarcinoma from the stomach. Therefore, he was classified as having stage IV (T1N1M1) gastric cancer. In cases of a hepatoid adenocarcinoma of the stomach, even patients with early gastric cancer can be staged into the poor prognostic group.
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma , Carcinoma, Hepatocellular , Dyspepsia , Gastrectomy , Liver , Lymph Nodes , Neoplasm Metastasis , Prognosis , Stomach Neoplasms , Stomach , Tomography, X-Ray ComputedABSTRACT
A hepatoid adenocarcinoma of stomach, a subtype of gastric cancr, is characterized by a histologic resemblance to a hepatocellular carcinoma and alpha-feto protein production. Another feature is early metastasis to the liver and lymph nodes, thus revealing a poor prognosis. We report a case of a hepatoid adenocarcinoma of the stomach with liver metastasis. A 52-year-old male visited our hospital with a chief complaint of indigestion. Gastroscopic examination showed a Borrmann type-II lesion on the lesser curvature of the antrum. The CT scan showed a suspected advanced gastric cancer with liver metastasis. The serum AFP level was 123 ng/ml. A radical subtotal gastrectomy and a right hemihepatectomy were performed simultaneously. Pathologic examination confirmed the lesion to be confined to the submucosa. The gastric lesion was a hepatoid adenocarcinoma, and the hepatic lesion was a metastatic adenocarcinoma from the stomach. Therefore, he was classified as having stage IV (T1N1M1) gastric cancer. In cases of a hepatoid adenocarcinoma of the stomach, even patients with early gastric cancer can be staged into the poor prognostic group.