Korean J Gastroenterol.  2012 Oct;60(4):262-266. 10.4166/kjg.2012.60.4.262.

A Case of Hepatic Metastasis of Gastric Hepatoid Adenocarcinoma Mistaken for Primary Hepatocellular Carcinoma

• Moon JY
• Kim GH
• Cheong JH
• Lee BE
• Ryu DY
• Song GA

• KMID: 1775812
• DOI: http://doi.org/10.4166/kjg.2012.60.4.262

Abstract

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.

Keyword

Gastric hepatoid adenocarcinoma; Alpha-fetoproteins; Stomach neoplasms

MeSH Terms

Adenocarcinoma/*diagnosis/pathology/surgery
Aged
Carcinoma, Hepatocellular/*diagnosis/therapy
Embolization, Therapeutic
Endoscopy, Gastrointestinal
Homeodomain Proteins/metabolism
Humans
Keratin-20/metabolism
Keratin-7/metabolism
Liver Neoplasms/diagnosis/*secondary/therapy
Male
Stomach Neoplasms/*diagnosis/pathology/surgery
Tomography, X-Ray Computed
alpha-Fetoproteins/analysis

Figure

• 

  Fig. 1 Endoscopy revealed a protruding tumor with a central ulceration at the anterior wall of the antrum. It was thought to be Borrmann type II advanced gastric cancer.

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  Fig. 2 Abdominal CT scan. (A) Arterial phase CT scan showed contrast enhancement of the tumor. (B) Portal venous phase CT scan showed washout of contrast from the tumor.

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  Fig. 3 Microscopic findings (H&E, ×200). (A) Stomach resection. Tumor in the stomach showed tubular-moderately differentiated adenocarcinoma. (B) Liver biopsy. Tumor in the liver showed glandular structure with hepatoid differentiation.

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  Fig. 4 Immunohistochemistry staining of gastric and liver biopsy specimen (×200). CK20, CK7 and CDX2 were positive in both specimen and CK19 was positive in liver biopsy specimen. Expression of CK20, CK7 and CDX2 were usually seen in gastrointestinal origin and CK20, CK7 and CDX2 negative epithelial neoplasm included primary hepatocellular carcinoma.

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  Fig. 5 AFP stain was positive in the liver biopsy specimen (Immunohistochemical stain, ×200).

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