Abstract
A 70-year-old man who was during treated for intractable gastric ulcer at a local hospital was admitted to our hospital to evaluate a pancreatic body tumor found by abdominal CT. Initial laboratory data indicated high level of serum AFP. Gastrointestinal endoscopy performed at the local hospital had revealed an ulcer in the antrum of the stomach. Biopsy specimens did not demonstrate malignancy. Ultrasonography revealed a well-defined tumor with a diameter of 41×31mm in the pancreatic body. MRI revealed no narrowing of the main pancreatic duct. Fine-needle aspiration biopsy demonstrated poorly differentiated adenocarcinoma. Upon laparotomy, a thickening of the lower gastric wall suggested a malignant tumor was also found together with the pancreatic tumor. We performed distal pancreatectomy and distal gastrectomy. Since both gastric and pancreatic tumors were positive for AFP immunohistochemical staining, we entertained the diagnosis of AFP-producing gastric cancer with lymph node metastasis which mimicked pancreatic cancer. Postoperatively, the Serum AFP decreased. He underwent adjuvant chemotherapy with S-1 and is currently without recurrence.
