Hepatoid adenocarcinoma of the stomach: A report of three cases

Abstract

Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer that has unique clinicopathological features and an extremely poor prognosis. Here, we report on three patients with suspected gastric cancer who were referred to our hospital. Gastrointestinal fiberscopy on the three patients revealed two lesions in the antrum and a third lesion in the gastroesophageal junction. The alpha fetoprotein (AFP) serum levels were markedly elevated in all cases. At the time of diagnosis, two cases were advanced stages with lymph nodes and/or liver metastases. Two patients underwent exploratory laparotomy. A total gastrectomy was performed on the operable lesion, and an expanded gastrectomy was completed in the case with hepatic metastases. Histopathological analysis revealed that the tumors displayed two pathological changes: hepatoid-like foci and adenocarcinomatous. Furthermore, the tumor cells were immunohistochemically positive for AFP, alpha-1 antitrypsin, and alpha-1 antichymotrypsin. All three patients received chemotherapy. The follow-up duration ranged from 8-36 mo. Our experience and previous published studies have suggested that HAS is an aggressive type of adenocarcinoma. However, radical surgery and chemotherapy may positively impact clinical outcomes.

Hepatoid adenocarcinoma of stomach: a morphological curiosity

“…6,8 The cells are large and polygonal with prominent nucleoli, prominent cell borders, central nuclei and abundant cytoplasm. 6,9 The morphology of tumour foci resembles hepatocellular carcinoma.…”

“…6,9 The morphology of tumour foci resembles hepatocellular carcinoma. 8 These tumours show positivity for AFP, carcinoembryonic antigen, alpha 1-antitrypsin and alpha 1-antichymotrypsin on IHC. 6,8,9 Positive AFP staining on histopathology varies from 73.7% -91.6 %.…”

“…9 Epigast ric pain and generalized fatigue caused by anaemia are common symptoms. 8 Most studies suggest antrum as the most common site for HAS. 8 In a recent study, 4 the tumour was located in cardia in 42.1%, body in 36.8% and in antrum in 21.1%.…”

“…8 Most studies suggest antrum as the most common site for HAS. 8 In a recent study, 4 the tumour was located in cardia in 42.1%, body in 36.8% and in antrum in 21.1%. Serum AFP levels decrease rapidly after gastrectomy and definitive diagnosis is made by characteristic histopathological features and not on AFP production.…”

“…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. 9 Epigast ric pain and generalized fatigue caused by anaemia are common symptoms.…”