Abstract
Alpha-Fetoprotein (AFP)-producing gastric cancer is a rare tumor with high rates of lymph node/liver metastasis and a poor prognosis. We report a case of AFP-producing gastric cancer with synchronous and multiple liver metastases, which disappeared after gastrectomy and chemotherapy ; long-term survival was observed after resection of a metachronous lung metastasis. A 55-year-old man underwent upper GI endoscopy because of anemia. A type 2 tumor was detected in the lower body of his stomach. The biopsy result was poorly differentiated adenocarcinoma. The serum AFP level was elevated up to 4,000 ng/ml. CT scan revealed multiple liver metastases and lymph node metastases. Distal gastrectomy with D2 lymph node dissection was performed. The tumor cells were partly positive for AFP staining. After the surgery, continuous hepatic arterial infusion chemotherapy with 5-FU and epirubicin combined with systemic chemotherapy with S-1 was started. Serum AFP was lowered below the normal level after 6-month treatment. Liver metastases also became undetectable on imaging. Chemotherapy was switched to oral tegafur/uracil ; however, a lung metastasis emerged with elevation of AFP. Partial resection of the lung via video-assisted thoracic surgery was performed ; subsequently, no recurrence has been detected for seven years and seven months after the first operation.
