Hepatoid adenocarcinoma of the stomach--proper identification and treatment remain a challenge

Abstract

Objective: The term hepatoid adenocarcinoma (HAC) of the stomach was introduced three decades ago with the observation of high serum α-fetoprotein (AFP) levels in some gastric adenocarcinoma patients. This very rare gastric cancer patient subgroup is likely frequently misdiagnosed.

Material: Two patients who were recently diagnosed with HAC of the stomach at our institution are presented. We also performed a structured literature search and reviewed pertinent articles to provide knowledge to improve the proper identification, diagnosis and management of patients with gastric HAC.

Results: HAC is a rare subgroup of gastric carcinoma with poor prognosis. Clinical management of this population may be challenging. The scientific literature is largely based on very small patient series or case reports, and the evidence for proper decision making and management is considered weak.

Conclusion: All physicians involved in the diagnosis and treatment of patients with gastric cancer should pay attention to this rare subgroup to improve identification.

Keywords: Alpha-fetoprotein; gastric; hepatoid adenocarcinoma; prognosis; stomach.

Figure 1.

Pt #1: Male 48 years of age. Endoscopic view of the gastric tumour located in the fundus.

Figure 2.

Time trends of the AFP levels in Pt #1 during the trajectory of his disease.

Figure 3.

Pt #1: Coronal multi detector computer tomography(MDCT) shows the gastric tumour (T) in the left hypochondrium with infiltration of the left hemidiaphragma (stapled arrow) and the greater curvature (arrow) of the stomach.

Figure 4.

(A) Histopathology of hepatoid carcinoma in the gastric mucosal primary lesion The tumour comprised a mixture of pseudoglandular and hepatoid components. Note the normal glandular structure (arrows) (haematoxylin and eosin staining; original magnification, ×400). (B) Immunohistochemical staining showing intracytoplasmic positivity for AFP (dark brown). Note the non-staining normal glandular structure (arrows) (original magnification, x400).

Figure 5.

Pt # 2: Female 81 years of age. (A) Axial MDCT at the time of diagnosis showing the gastric tumour (T) located in the antrum, with lymph nodes (LN) at the lesser curvature. (B) Five months after primary diagnosis: disease progression with liver metastasis (M), tumour and lymph node growth (T) along the lesser curvature, ascites (A) and thrombus in portal veins (white arrow).