A Case of Alpha-fetoprotein-producing Gastric Cancer with Synchronous Pancreatic Metastasis Resected by Pancreaticoduodenectomy

Abstract

A 65-year-old man presented with a chief complaint of postprandial nausea. Upper endoscopy revealed a circumferential type 3 tumor in the gastric antrum and a submucosal tumor with depression at the superior duodenal angle. On biopsy, the gastric lesion was diagnosed as moderately-differentiated adenocarcinoma, but no definitive diagnosis was obtained for the duodenal lesion. Computed tomography (CT) showed wall thickening in the gastric antrum and a tumor with poor contrast enhancement in the pancreaticoduodenal region. Based on diagnoses of cancer of the gastric antrum and either a duodenal submucosal tumor or duodenal invasion of subpyloric lymph node metastasis, pancreaticoduodenectomy was performed. Histopathological examination of the resected sample yielded diagnoses of alpha-fetoprotein (AFP)-producing gastric cancer and hematogenous pancreatic metastasis. AFP-producing gastric cancer leading to hematogenous pancreatic metastasis is extremely rare, and the present case is reported, along with a review of the literature.