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

Abstract

BackgroundGastric 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 presentationA 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.ConclusionsGHAC 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.

Α-fetoprotein producing hepatoid gastric adenocarcinoma with neuroendocrine differentiation

“…Hepatoid gastric adenocarcinoma is a rare pathological type which accounts for ≤1% in all gastric cancer. [ 1 , 2 ] It has a similar morphological feature with hepatocellular carcinoma in the pathological examination. It has been known that not all hepatoid gastric adenocarcinoma produce AFP, some patients express negative.…”

“…It has been known that not all hepatoid gastric adenocarcinoma produce AFP, some patients express negative. [ 1 ] Although hepatoid adenocarcinoma is the most common, there are some other types of AFP-producing gastric cancer, such as yolk sac tumor-like and fetal gastrointestinal type. [ 1 , 9 ] And in some AFP producing cases, the component of the tumor is not unique.…”

“…Hepatoid gastric adenocarcinoma is a rare type of gastric cancer, which accounts for ≤1% in all gastric cancer. [ 1 , 2 ] It is similar to hepatocellular carcinoma, and may produce α-fetoprotein (AFP). However, some patients present a normal AFP level, and some AFP producing gastric cancer is not hepatoid adenocarcinoma.…”

“…However, there is still no specific treatment. [ 1 , 2 , 4 – 8 ] The relevant fields need further research. Here, we present a case of AFP producing hepatoid gastric adenocarcinoma with neuroendocrine differentiation and summarize the relevant literature.…”

Multiple hepatoid gastric adenocarcinoma: A case report and literature review

“…Hepatoid gastric adenocarcinoma (HGAC), which was first reported by Ishikura in 1985, 1 is a rare malignancy, accounting for only 1% of all gastric cancers. 2,3 A differentiated HGAC shares characteristics with both hepatocellular carcinoma (HCC) and gastric adenocarcinoma (GC), and is often accompanied by a high serum alpha-fetoprotein (AFP) concentration. However, AFP is not a definitive biomarker, as some patients with HGAC have normal serum AFP concentrations, while some gastric cancers that are not hepatoid adenocarcinomas can produce AFP.…”