Alpha-Fetoprotein-Producing Early Gastric Cancer of the Remnant Stomach: Report of a Case

Abstract

A 67-year-old man initially underwent a distal gastrectomy for early gastric cancer (T1, N0, M0; Stage IA) in March 1995. During the follow-up period, an elevation of the serum alpha-fetoprotein (AFP) level (98.8 ng/ml) and a liver tumor (S4) were detected. A left hepatectomy was performed in December 1996. Immunohistochemically, AFP-positive cells were present in both the primary gastric tumor and metastasized liver tumor. The serum AFP level normalized immediately, but it elevated again to 22.4 ng/ml. An endoscopic examination revealed a protruding lesion in the remnant stomach. A total resection of the remnant stomach was performed in February 2005. The tumor was evaluated T1, N0, M0; Stage IA, with positive staining for AFP. The patient has survived without any sign of recurrence for more than 11 years after the first diagnosis of cancer. To the best of our knowledge, this is the first case of a long-term survival of AFP-producing gastric cancer with successfully resected metachronous liver metastasis and gastric remnant carcinoma.

An isolate alpha-fetoprotein producing gastric cancer liver metastasis emerged in a patient previously affected by radiation induced liver disease

“…quently described and is associated with a poor prognosis for vascular invasion, regional lymphadenopathy and frequent liver metastases [1][2][3][4][5] . Terracciano et al [6] showed positivity in virtually all HACs for AFP, cytokeratin-8 (CK-8), CK-18 and carcinoembryonic antigen, markers underlining its hepatoid nature, the contemporary positive staining for CK-19 and CK-20, and the frequent negativity of Hep Par1 in both primary tumors and their metastases.…”

“…Several case reports of alpha-fetoprotein (AFP) producing gastric cancer have been described [1][2][3][4][5] . It represents 3.9%-11% of all the neoplasia of the stomach collected in a Japanese series.…”

“…Whether AFP-producing gastric cancer is associated with frequent liver metastases [1][2][3][4][5] , no cases of gastric cancer liver metastases emerging in a site of the liver previously affected by RILD were described. However, we were encouraged to describe the case because, in our opinion, the…”

Gastric choriocarcinoma admixed with an α-fetoprotein-producing adenocarcinoma and separated adenocarcinoma

“…AFP-producing tumors have been reported in several different organs, and commonly in the stomach [4][5][6][7][8] . The proportion of gastric cancers that secrete AFP has been reported to be 2.7%-8.0% [9] . AFP-producing gastric carcinomas have high proliferative activity and are associated with low levels of apoptosis and rich neovascularization.…”

Alpha-fetoprotein producing Gastric carcinoma : A rare entity

“…[3][4][5][6][7][8][9] (Table 1) AFP producing gastric cancer (AFPGC) constitutes only about 2.7% to 8% of all gastric cancers. 10 They have high metastatic potential and possibility of vascular invasion, liver and lymph nodal metastases resulting in poor prognosis. 2 In situations where associated liver mass is seen, it may be mistaken for coexistent hepatocellular carcinoma, like the index case.…”