A Case Report of a Long-surviving Patient with Gastric Cancer Producing α-fetoprotein and Human Chorionic Gonadotropin that Showed Various Histopathological Features

Abstract

A case of gastric cancer producing α-fetoprotein (AFP) and human chorionic gonadotropin (HCG) that showed various histopathological features is presented. A 70-years-old man was found to have abnormalities of the stomach on a medical examination and was admitted to our hospital. Gastrointestinal endoscopy showed an elevated lesion, similar to type 1 gastric cancer, in the anterior wall of the upper body. In addition, abdominal enhanced CT showed several heterogeneously enhanced lymph node swellings in the side of the lesser curvature. Serum levels of AFP and HCG were high (15.7 ng/mL and 552 mIU/mL, respectively). A diagnosis of cStage II gastric cancer was made, and total gastrectomy and splenectomy were performed. On postoperative histopathological examination, this tumor was seen to consist of 4 components, moderately to poorly differentiated adenocarcinoma, a hepatoid adenocarcinomatous lesion (AFP-positive), a choriocarcinomatous lesion (HCG-positive), and a seminomatous lesion (placental alkaline phosphatase (PALP)-positive). Since the operation was curative, there has been no sign of recurrence up to the present, 6 years and 6 months after the operation. Gastric cancer with high serum AFP and HCG levels is rare. Moreover, it is thought that the prognosis of cases that are positive for these tumor-associated antigens is very poor. Since a long-surviving case with gastric cancer producing both AFP and HCG is extremely rare, this case is presented along with a review of the literature.