Hepatoid adenocarcinoma of the stomach: A case report of a rare type of gastric cancer

Abstract

Hepatoid adenocarcinoma of the stomach (HAS) is a rare type of gastric cancer with an extremely poor prognosis. The current study reports a rare case of HAS, characterized by gastric cancer and infiltration of cancer cells into the left liver lobe, as well as lymphadenectasis. The expression of α-fetoprotein (AFP) was markedly increased in the tumor cells of the liver neoplasms. A gastric biopsy indicated highly, moderately and poorly differentiated papillary adenocarcinoma. The patient underwent two cycles of chemotherapy with oxaliplatin (130 mg; day 1) and capecitabine (2 mg, twice daily; days 1-14). At 7 weeks after the chemotherapy, an expanded gastrectomy and radical resection of left lung lobe were performed on the operable lesion. AFP expression was significantly decreased following the procedure. A literature review was also conducted by searching PubMed/Medline, indicating that surgery and chemotherapy may positively affect the outcomes of HAS patients.

Keywords: chemotherapy; gastric cancer; hepatoid adenocarcinoma of stomach; prognosis; α-fetoprotein.

Figure 1.

Imaging results. (A) Computed tomography imaging revealed a lesion in the left lobe of the liver prior to surgery. (B) Endoscopy identified a protruding lesion in the gastric antrum prior to chemotherapy.

Figure 2.

Histochemical and immunostaining results. (A) Highly differentiated adenocarcinoma and small cellular atypia was identified in gastric samples (H&E staining; magnification, ×100). (B) Poorly differentiated adenocarcinoma was identified in hepatic samples; the tumor demonstrated an infiltrative growth pattern (H&E staining; magnification, ×100). (C) Poorly, moderately and highly differentiated hepatocellular carcinomas were identified in the liver (H&E staining; magnification, ×200). (D) Poorly differentiated adenocarcinoma was identified in the gastric sample, which exhibited hepatocyte-like differentiation and interstitial edema (H&E staining; magnification, ×200). (E) α-fetoprotein expression in hepatic samples (magnification, ×100). H&E, hematoxylin and eosin.