Gastric hepatoid adenocarcinoma: A computed tomography report of six cases

Abstract

We describe the computed tomography (CT) imaging findings in six cases (five males and one female; age range 61-78 years; mean age 67.3 years) with histologically proven hepatoid adenocarcinoma of the stomach (HAS). Five of the six patients had elevated serum alpha-fetoprotein levels. The most common type of gross appearance HAS on CT is a polypoid mass (83%, 5/6). The most common contrast enhancement pattern was heterogeneous. All six patients had a regional lymphadenopathy larger than 6 mm in its short axis. Liver metastases (n = 3) were noted. Venous tumor thrombosis was identified in the portal vein (n = 2) of the regions near primary gastric tumors or metastatic masses. Our findings suggest in an elderly, male patients with a large heterogeneous enhancement tumor, the presence of distant metastases, regional lymphadenopathy and characteristically increased serum alpha-fetoprotein levels indicates a high likelihood of HAS.

Hepatoid adenocarcinoma of stomach: a morphological curiosity

“…Serum AFP levels decrease rapidly after gastrectomy and definitive diagnosis is made by characteristic histopathological features and not on AFP production. 5 In our case we did not estimate serum AFP pre-operatively.…”

“…The reported incidence varies from 0.17 to 15 % [2][3][4][5] and is common in elderly males. [2][3][4][5][6] The youngest case was reported in a 12-year-old boy.…”

“…1,5 Hepatoid adenocarcinomas have also been report ed in ot her organs, such as oesophagus, jejunum, colon, rectum, gall bladder, lung, peritoneum, urinary bladder, renal pelvis, pancreas, ovaries, uterus and papilla of vater. 6,8 Preoperative diagnosis is difficult as patients present with symptoms similar to other digestive cancers.…”

“…5 Morphological appearance of enhancement pattern on CT may assist in distinguishing HAS from other types of advanced gastric carcinoma. 5 Radical surgery with negative margins remains the main stay of treatment in the absence of distant metastasis. Currently, there are no standard regimens for HAS and chemotherapy response is poor compared to common gastric adenocarcinoma regimens.…”

Alpha-feto protein negative hepatoid carcinoma of likely primary peritoneal origin: a case report and literature review

“…On computed tomography, hepatoid carcinoma may present as a heterogeneously enhancing mass [9] . Both computed tomography and magnetic resonance imaging play a crucial role in the detection of a possible hepatocellular primary [10] .…”