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Review
. 2017 May 25;17(1):368.
doi: 10.1186/s12885-017-3357-7.

Gastric hepatoid adenocarcinoma resulting in a spontaneous gastric perforation: a case report and review of the literature

Junichi Yoshizawa  1   2 , Satoshi Ishizone  3 , Meguru Ikeyama  4 , Jun Nakayama  4
Affiliations
Review

Gastric hepatoid adenocarcinoma resulting in a spontaneous gastric perforation: a case report and review of the literature

Junichi Yoshizawa et al. BMC Cancer. .

Abstract

Background: Gastric hepatoid adenocarcinoma (GHAC) is an atypical form of gastric cancer (GC) that has similar tissue morphology to hepatocellular carcinoma and frequently produces alpha-fetoprotein. We present an exceedingly rare case of GHAC resulting in a spontaneous gastric perforation.

Case presentation: A 61-year-old man presented at our institution complaining of abdominal and back pain. A computed tomography scan revealed a spontaneous gastric perforation with a solitary liver tumor and lymph node swelling. Following a diagnosis of advanced-stage GC with a gastric perforation, perforative peritonitis, multiple lymph node metastases, and a solitary metastasis of the lateral segment of the liver, the patient underwent distal gastrectomy. Histopathology of the resected specimen revealed that the tumor cells were arranged in a hepatoid pattern. On immunohistochemical staining, the tumor cells were positive for alpha-fetoprotein and Sal-like protein 4. Thus, the patient was diagnosed with GHAC. Hepatic resection of the solitary liver metastasis was performed. However, recurrence occurred and the patient achieved complete response following tegafur/gimeracil/oteracil-based chemotherapy.

Conclusions: GHAC is a highly malignant histological subtype of GC. We reported on an extremely rare case of GHAC resulting in a spontaneous gastric perforation and reviewed the literature, including epidemiological data, treatment regimens, and the association between GHAC and alpha-fetoprotein-producing GC.

Keywords: Alpha-fetoprotein; Case report; Gastric cancer; Gastric perforation; Hepatoid adenocarcinoma.

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Figures

Fig. 1
Fig. 1
Imaging findings. Abdominal contrast-enhanced computed tomography revealed disruption and thickening of the anterior wall of the gastric antrum with free air (a) and a low enhanced lesion (30 mm in diameter) on the lateral segment of the liver (b)
Fig. 2
Fig. 2
Intraoperative findings. A 7-mm perforation of the anterior wall of the gastric antrum with serous exposure of bulky tumors and opacity ascites
Fig. 3
Fig. 3
Gross findings. Ulcerative and infiltrative (type 3) tumor of the gastric antrum (approximately 100 × 50 mm) with an infiltrative serosal surface and central perforation of the gastric cancer
Fig. 4
Fig. 4
Histopathological findings. Hematoxylin and eosin staining of proliferating tumor cells with solid or thick-trabecular patterns mimicking hepatocellular carcinoma. The scale bars in (a) and (b) indicate 200 μm and 50 μm, respectively
Fig. 5
Fig. 5
Immunohistochemical analysis. Tumor cells stained positive for (a) alpha-fetoprotein and (b) Sal-like protein 4, but were negative for (c) carcinoembryonic antigen, (d) synaptophysin, (e) chromogranin A, and (f) neural cell adhesion molecule. The scale bar indicates 50 μm
See this image and copyright information in PMC

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