Alpha-Fetoprotein-Producing Gastric Cancer With Delayed Diagnosis Caused by COVID-19: A Case Report

Abstract

A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19). The patient had suspected upper gastrointestinal bleeding during the course of the COVID-19 infection. Urgent esophagogastroduodenoscopy (EGD) was performed. However, because of mobility restrictions imposed as a COVID-19 countermeasure, EGD was done in a small hospital room. Hemostatic treatment was successful, but no sufficient close examination could be done. The patient, who was diagnosed as having alpha-fetoprotein-producing gastric cancer, died about three months later.

Keywords: alpha-fetoprotein-producing gastric cancer; covid-19; delayed diagnosis; upper gastrointestinal bleeding; urgent esophagogastroduodenoscopy.

Figure 1. Chest computed tomography showing subpleural ground-glass shadows in the bilateral lower lobes. Typical image of acute interstitial pneumonia as coronavirus disease 2019.

Figure 2. Esophagogastroduodenoscopy showing a widespread ulcer with an exposed vessel in the gastric fornix (a). Therefore, endoscopic hemostasis was performed using hemoclips (b).

Figure 3. Chest computed tomography showing improvement of pneumonia (a). Abdominal gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (hepatocyte phase) showing multiple tumors in the liver (b). Multiple tumors with ring-shaped contrast effect without early stain, and the lesion is unlikely to be hepatocellular carcinoma.

Figure 4. Esophagogastroduodenoscopy showing diffuse, borderless, irregularly shaped ulcers from the esophagogastric junction to the fornix and corpus of the stomach (a and b). Biopsy specimen from the edge of the ulcer diagnosed poorly differentiated adenocarcinoma (c, hematoxylin and eosin staining ×200). Alpha-fetoprotein immunohistochemical staining was positive (d, ×200).