J Korean Surg Soc.  2009 Jun;76(6):403-407. 10.4174/jkss.2009.76.6.403.

Hepatoid Adenocarcinoma of the Stomach Misconceived as a Primary Liver Tumor

• Park DE
• Lee HB
• Chae KM

• KMID: 1464959
• DOI: http://doi.org/10.4174/jkss.2009.76.6.403

Abstract

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.

Keyword

Hepatoid adenocarcinoma of the stomach; AFP(alpha-fetoprotein)

MeSH Terms

Abdominal Pain
Adenocarcinoma
Aged
alpha-Fetoproteins
Biopsy
Early Diagnosis
Gastrectomy
Hepatectomy
Humans
Liver
Male
Neoplasm Metastasis
Prognosis
Pylorus
Stomach
alpha-Fetoproteins

Figure

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  Fig. 1 Abdominal CT shows a huge well-defined low attenuation mass in right liver.

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  Fig. 2 The resected right liver contained a 11 cm-sized whitish mass with lobulated contour (H&E stain, ×200).

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  Fig. 3 (A) The tumor was composed of cords of large polygonal cells with abundant eosinophilic cytoplasm arranged in trabecular pattern, hepatocelluar carcinoma-like cells (H&E stain, ×200). (B) The resected stomach was reexamined. There are hepatocellular carcinoma-like components and tubular adenocarcinoma components in a same specimen (H&E stain, ×100).

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  Fig. 4 A 5.5 cm-sized mass contained cystic and solid components shown on abdominal CT at 4 months after extended right hepatectomy was done.

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  Fig. 5 At 2 months after caudate lobectomy, multiple metastases developed in liver (A), lungs (B) and paraaortic nodes.

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