1989 Volume 31 Issue 2 Pages 442-448_1
In many gastric cancers producing AFP, some cases have features of hepatic differentiation. A patient with primary gastric adenocarcinoma with extremely high serum AFP level (61, 200 ng/ml) is described (Table 1). X-ray and endoscopic examination (Figure 1, 2) showed a Borrmann type 1 carcinoma on the anterior wall of the upper to middle body of the stomach. Well-differentiated adenocarcinoma was comfirmed by biopsy. Liver metastasis was not detected by CT, Ultrasonography and angiography (Figure 3). Total gastrectomy was performed. No metastases were found in any ather organs. Postoperative serum AFP level became normal (Figure 6). In the upper to middle body of the stomach, a well-circumscribed nodular tumor of 11 × 7.0 × 4.0 cm in size was found. Bleeding and necrosis were noted on the surface (Figure 4). The tumor cells contained eosinophilic cytoplasm that were similar to hepatocellar carcinoma, and they formed medullary nests. In some area, adenocarcinoma cells were well-differentiated tubular type (Figure 5). Immunohistochemical studies (Table 2) showed that tumor cells were positive for AFP (Figure 7), alpha-1 antitypsin, alpha-1 antichymotypsin, albumin, prealbumin (Figure 8), prothrombin, transf errin, ferritin and CEA (Figure 9), but negative for human chorionic gonadotropin. This case is compatible with “Hepatoidadenocarcinoma of the stomach” reported by Ishikura et al.
