A case of afp-producing gastric cancer with portal tumor thrombus accompanied by rupture of the metastatic lymph nodes

Abstract

A 28-year-old man attended our emergency department with abdominal pain and anemia. Abdominal-enhanced CT suggested gastric cancer and peritoneal bleeding, following rupture of the metastatic lymph nodes, and the patient was emergently admitted. Gastrointestinal endoscopy revealed a type 2 tumor at the posterior wall of the gastric angle. A biopsy specimen showed poorly differenciated adenocarcinoma, while immunohistochemical staining was positive for alpha-fetoprotein (AFP). The serum AFP level was 133.7ng/ml. Abdominal-enhanced CT performed as a preoperative assessment showed a defect in the superior mesenteric vein (SMV), indicating portal tumor thrombus. Total gastrectomy, splenectomy, D2 lympadenectomy, and removal of the tumor thrombus were performed. AFP-producing gastric cancer, T2(MP)N3aM1(OTH)H0 P0, stageIV, was pathologically diagnosed. The patient underwent adjuvant chemotherapy with S-1. After 1 year, there was no evidence of recurrence. Here, we present the case history and definitive surgery of this rare case of AFP-producing gastric cancer with portal tumor thrombus, which was accompanied by rupture of the metastatic lymph nodes.