Abstract
A 38-year-old female presented with abdominal pain and tarry stool. Barium study and gastroscopy showed type 4 gastric cancer. When she was first seen, serum CEA and AFP levels were elevated. Since washing cytology during diagnostic laparoscopy was positive, prior to surgery neo-adjuvant chemotherapy with S-1 + CDDP was administered. After two cycles of the chemotherapy, serum CEA level dropped into the normal range while AFP level continued to increase. Diagnostic laparoscopy performed again showed no peritoneal seeding and negative cytology, and then curative total gastrectomy with splenectomy was performed. Pathological examination demonstrated degeneration due to the chemotherapy in the ordinary adenocarcinoma component, but not in the AFP-producing hepatoid component. Postoperatively, AFP level increased and an abdominal CT scan at two months after the operation showed multiple liver metastases. This case of gastric cancer is rare in that entirely different responses to chemotherapy were shown between the components constituting the lesion, and is suggestive of changes of serum tumor marker levels during neo-adjuvant chemotherapy.
