Solitary AFP- and PIVKA-II-producing hepatoid gastric cancer with giant lymph node metastasis

Hepatogastroenterology. 2005 Nov-Dec;52(66):1930-2.

Abstract

A 61-year-old man was admitted to our hospital because of abdominal pain and an abdominal mass. The patient had anemia and elevated serum alpha-fetoprotein (AFP) (9630ng/mL) and PIVKA-II (91mAU/mL) levels. Roentgenographic examination revealed an extra-gastric tumor in the upper abdomen, and gastroscopy revealed Bormann type 2 gastric cancer in the lower portion of the stomach. The preoperative diagnosis was synchronous gastric cancer and hepatocellular carcinoma (HCC), and surgery was performed. The extra-gastric tumor appeared to be an extra-hepatically growing HCC because the tumor was fed by vessels ramifying from the umbilical portion of the liver. Distal gastrectomy with resection of the extra-gastric tumor was performed, and histological examination of the resected specimen revealed that the gastric cancer was an AFP-producing hepatoid gastric adenocarcinoma and that the extra-gastric tumor was a lymph node metastasis. AFP-producing hepatoid gastric adenocarcinoma tends to metastasize to the regional lymph nodes and form a giant tumor. A giant tumor in the upper abdomen associated with gastric cancer may therefore be a clinical manifestation of AFP-producing hepatoid gastric adenocarcinoma.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / etiology
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Angiography / methods
  • Biomarkers / analysis
  • Biomarkers, Tumor / analysis*
  • Biopsy, Needle
  • Carcinoma, Hepatocellular / pathology*
  • Carcinoma, Hepatocellular / surgery
  • Follow-Up Studies
  • Gastrectomy / methods
  • Humans
  • Immunohistochemistry
  • Lymph Nodes / pathology*
  • Male
  • Middle Aged
  • Neoplasm Invasiveness / pathology*
  • Neoplasm Staging
  • Protein Precursors / analysis
  • Prothrombin / analysis
  • Risk Assessment
  • Stomach Neoplasms / pathology*
  • Stomach Neoplasms / surgery
  • Treatment Outcome
  • Ultrasonography, Doppler / methods
  • alpha-Fetoproteins / analysis

Substances

  • Biomarkers
  • Biomarkers, Tumor
  • Protein Precursors
  • alpha-Fetoproteins
  • acarboxyprothrombin
  • Prothrombin