Hepatoid adenocarcinoma of the stomach: Nine case reports and treatment outcomes

Abstract

Hepatoid adenocarcinoma (HAC), an extrahepatic tumor, has notable morphological similarities to hepatocellular carcinoma, which has been reported in gastrointestinal tract organs, including the rectum, gallbladder, lung, ovary and urinary bladder. HAC of the stomach (GHAC) is a rare variant of gastric cancer, characterized by aggressive behavior and extremely poor prognosis. Correct diagnosis depends on clinicopathological and immunohistochemical studies. In the present study, we reported nine cases of GHAC who were treated in the First Affiliated Hospital of Zhejiang University, China, from January 2009 to December 2013. All patients underwent radical gastrectomy; among them, one patient had stage I, one had stage II and seven had stage III. Elevated serum α-fetoprotein was observed in eight cases. Until now, only one patient has succumbed, four patients have liver metastases, one has lung metastasis and four remain disease-free. Relatively longer survival requires accurate diagnosis at an earlier stage and active multimodality treatment, including radical gastrectomy and adjuvant chemotherapy.

Keywords: hepatoid adenocarcinoma; immunohistochemistry; serum α-fetoprotein; stomach; treatment.

Figure 1.

Immunohistochemical features of hepatoid adenocarcinoma of the stomach. (A) Hematoxylin and eosin staining: tumor cells are arranged in a trabecular pattern with eosinophilic cytoplasm and an abundance of blood sinus, with a glandular and hepatoid component (magnification, x100). (B) Immunohistochemical staining: cells are positively stained for α-fetoprotein (magnification, x100). (C) Immunohistochemical staining: cells are positively stained for synaptophysin (magnification, x100). (D) Hematoxylin and eosin staining of liver metastases: liver metastases demonstrated hepatoid differentiation, virtually indistinguishable from hepatocellular carcinoma (magnification, x400).