Gastric Metastasis from Hepatocellular Carcinoma

Abstract

We report a case that was initially diagnosed as gastric cancer which turned out to be a hepatic metastasis.

A 59-year-old male patient was referred to our hospital with a diagnosis of gastric cancer. He had a history of non-B non-C hepatocellular carcinoma (HCC) that had recurred several times, and he had undergone radiofrequency ablation thrice and transarterial chemoembolization thrice since February 2019. Imaging examinations confirmed disappearance of the liver lesion. In March 2021, the patient presented with anemia, and an upper gastrointestinal endoscopic examination revealed a type 1 lesion in the middle third of the gastric body and a superficial esophageal cancer with suspected submucosal invasion in the mid-thoracic esophagus. Biopsy of the stomach tumor revealed poorly differentiated adenocarcinoma, and that of the esophageal tumor revealed moderately differentiated squamous cell carcinoma.

In addition, the patient showed a sharp increase of the serum level of alpha-fetoprotein isoform L3 (AFP-L3), which suggested the possibility of recurrence of the HCC. Thus, we decided to resect only the gastric tumor, because of bleeding from the tumor that necessitated frequent blood transfusions, but not the esophageal cancer. Distal gastrectomy was performed in May 2021, and the final histopathology report revealed the diagnosis of gastric metastasis from HCC. After the operation, the serum AFP-L3 level decreased rapidly.