Hepatoid adenocarcinoma of the stomach: an unusual case of elevated alpha-fetoprotein with prior treatment for hepatocellular carcinoma.
10.3350/cmh.2013.19.2.173
- Author:
Joon Seong AHN
1
;
Ja Ryong JEON
;
Hong Seok YOO
;
Taek Kyu PARK
;
Cheol Keun PARK
;
Dong Hyun SINN
;
Seung Woon PAIK
Author Information
1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. sw.paik@samsung.com
- Publication Type:Case Reports
- Keywords:
Hepatoid adenocarcinoma;
Hepatocellular carcinoma;
Stomach;
Metachronous
- MeSH:
Adenocarcinoma/*diagnosis/drug therapy/secondary;
Aged;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use;
Camptothecin/analogs & derivatives/therapeutic use;
Carcinoma, Hepatocellular/*diagnosis/drug therapy/pathology;
Chemoembolization, Therapeutic;
Chemotherapy, Adjuvant;
Fluorouracil/therapeutic use;
Gastroscopy;
Humans;
Leucovorin/therapeutic use;
Liver Neoplasms/*diagnosis/drug therapy/pathology;
Lymph Nodes/surgery;
Lymphatic Metastasis;
Male;
Recurrence;
Silicates/therapeutic use;
Stomach Neoplasms/*diagnosis/drug therapy/secondary;
Titanium/therapeutic use;
Tomography, X-Ray Computed;
alpha-Fetoproteins/*analysis
- From:Clinical and Molecular Hepatology
2013;19(2):173-178
- CountryRepublic of Korea
- Language:English
-
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.
