Clin Mol Hepatol.  2013 Jun;19(2):173-178. 10.3350/cmh.2013.19.2.173.

Hepatoid adenocarcinoma of the stomach: an unusual case of elevated alpha-fetoprotein with prior treatment for hepatocellular carcinoma

• Ahn JS
• Jeon JR
• Yoo HS
• Park TK
• Park CK
• Sinn DH
• Paik SW

• KMID: 1776805
• DOI: http://doi.org/10.3350/cmh.2013.19.2.173

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.

Keyword

Hepatoid adenocarcinoma; Hepatocellular carcinoma; Stomach; Metachronous

MeSH Terms

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
Silicates
alpha-Fetoproteins
Titanium
Leucovorin
Fluorouracil
Camptothecin