Clinicopathologic characteristics and treatment outcomes of hepatoid adenocarcinoma of the stomach, a rare but unique subtype of gastric cancer

Abstract

BackgroundGastric hepatoid adenocarcinoma (HAC) is a special type of gastric cancer that morphologically mimics hepatocellular carcinoma. In this study, we performed an evaluation of clinicopathologic characteristics, treatment outcome, and prognosis in patients with gastric HAC.MethodsWe consecutively enrolled patients with pathologically proven gastric HAC at Seoul National University Hospital between January 1996 and December 2008 and conducted a retrospective review. Among 15,253 patients with gastric cancer, 26 patients (0.17%) were diagnosed as gastric HAC.ResultsAmong 26 patients, 22 were male and the median age was 63. Stage at diagnosis was stage IB in 3 patients, stage II in 6 patients, stage III in 7 patients, and stage IV in 10 patients. Eight patients out of 18 patients with stage IB, II, III, and IV relapsed after curative surgery. Relapse-free survival for these patients was 16.67 months. The most common metastatic site was intraabdominal lymph nodes (n = 9), followed by the liver (n = 8). Thirteen patients received palliative chemotherapy. The most commonly used regimen was a combination of fluoropyrimidine and platinum. Partial response was observed in one patient and stable disease in 5 patients. Median overall survival and progression free survival of these patients were 8.03 (95% CI: 6.59-9.47) and 3.47 months (95% CI: 0.65-6.29), respectively.ConclusionsGastric HAC is a very rare but unique type of stomach cancer. Early detection of this type of cancer is of critical importance to patient prognosis. Additional studies to reveal the biology of this tumor are warranted.

Clinicopathologial features of gastric hepatoid adenocarcinoma

“…[12,13] Our study revealed a similar incidence rate (0.22%) with a high incidence of metastasis. According to a previously published report, [14] patients with GHA have an average age of 63.5 years, are predominantly male (2.32:1), have tumors mainly located at the antrum, and tend to have high levels of AFP.…”

“…As presented in our data, Borrmann's type III was the most common presentation of GHA, [13] which appeared as a fungating mass with a purple, berry-like surface [ Figure 2]. Ulceration in the presence of recent hemorrhage was also observed in some cases.…”

Hepatoid adenocarcinoma of the stomach: Nine case reports and treatment outcomes

“…Survival is closely associated with the pTNM stage. Baek et al reported that the median overall survival of patients with stages I-III and stage IV was 28.0 and 8.2 months, respectively (9). Relatively longer survival requires accurate diagnosis at an earlier stage as well as active multimodality treatment, including radical gastrectomy and adjuvant chemotherapy.…”

Hepatoid adenocarcinoma of the stomach: A case report and review of the literature

“…Therefore, in gastric tumor cases with an elevated serum AFP level, the possibility of HAS must be considered. Preoperative computed tomography and β-ultrasound of the liver are routinely recommended for the exclusion of HCC, hepatic metastasis, teratoma and other diseases that may also produce AFP (4,5,7). Histologically, the hepatoid structure identified in the gastric adenocarcinoma region may contribute significantly to the diagnosis (3)(4)(5)7).…”

“…Preoperative computed tomography and β-ultrasound of the liver are routinely recommended for the exclusion of HCC, hepatic metastasis, teratoma and other diseases that may also produce AFP (4,5,7). Histologically, the hepatoid structure identified in the gastric adenocarcinoma region may contribute significantly to the diagnosis (3)(4)(5)7). Immunohistochemical analysis may exhibit positive staining for epithelial membrane antigen and CEA, which may aid in the exclusion of gastric metastasis of HCC (4,8,10,11).…”