J Gastric Cancer.  2013 Mar;13(1):58-64.

Five-Year Survival of Alpha-Fetoprotein-Producing Gastric Cancer with Synchronous Liver Metastasis: A Case Report

• Koneri K
• Hirono Y
• Fujimoto D
• Sawai K
• Morikawa M
• Murakami M
• Goi T
• Iida A
• Katayama K
• Yamaguchi

Abstract

Alpha-fetoprotein-Producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.

Keyword

Stomach neoplasms; Alpha-fetoproteins; Drug therapy; General surgery; Sorafenib

MeSH Terms

Abdominal Pain
Administration, Oral
alpha-Fetoproteins
Cisplatin
Endoscopy, Gastrointestinal
Gastrectomy
Liver
Lymph Nodes
Neoplasm Metastasis
Niacinamide
Phenylurea Compounds
Potassium
Prognosis
Stomach
Stomach Neoplasms
Cisplatin
Niacinamide
Phenylurea Compounds
Potassium
alpha-Fetoproteins

Figure

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  Fig. 1 (A) Upper gastrointestinal endoscopy revealing a Borrmann type II like tumor at the posterior wall of the lower part of the stomach. (B) Upper gastrointestinal series showing the elevated lesion with central depression (arrow). (C) Abdominal CECT revealing a 14-cm-long hypovascular tumor the left lobe of the liver. (D) The resected specimen showing a Borrmann type II 2.8-cm-long tumor at the lower part of the stomach (arrow). CECT = contrast-enhanced computed tomography.

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  Fig. 2 (A) Histopathological examination revealing well-differentiated adenocarcinoma with neoplastic growth of hepatocyte-like cells in the gastric tumor (H&E stain, ×100). (B) The biopsy specimen from the liver tumor is similar to gastric tumor (H&E stain, ×100). (C) Immunohistological staining showing positive result for AFP in the gastric tumor (AFP, ×100). (D) The biopsy specimen from the liver tumor was also positive for AFP staining (AFP, ×100). AFP = alpha-fetoprotein.

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  Fig. 3 (A) CECT showing the liver metastasis in the left lobe decreased to 53.6% after 4 courses of oral TS-1/hepatic intra-arterial injection of cisplatin (arrows). (B) Resected specimen showing atrophic changes in the left lobe and a soft, odd-shaped liver tumor. (C) On cut section, the liver tumor is shown to be yellowish and highly-denatured inside of the tumor (arrows). (D) CECT showing the lung tumor at the left lobe of the lung (arrows). CECT = contrast-enhanced computed tomography.

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  Fig. 4 Patient's therapeutic course. AFP = alpha-fetoprotein; TS-1 = tegafur/gimeracil/oteracil potassium; HAI-CDDP = hepatic artery injection; CDDP = cisplatin; PTX = paclitaxel; DFUR = 5'-Doxifluridine; DOC = Docetaxel; FAM = 5-fluorouracil/Adriamycin/Mitomycin-C.

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  Fig. 5 (A) CECT after 54 months from first operation revealing the increasing size of liver metastases (arrows). (B) CECT revealing the increasing size of the mediastinal lymph nodes metastases (arrowheads). (C) CECT after 2 months of administering sorafenib revealing marked attenuation of vascularity at the liver metastasis (arrows). (D) The mediastinal lymph nodes shrunk by 16.2% in size (arrowheads). CECT = contrast-enhanced computed tomography.

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