Hepatoid adenocarcinomas of the stomach: An analysis of seven cases

Abstract

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. They usually produce large amounts of alpha-fetoprotein (AFP) with a Concanavalin A-binding property of hepatic type. In this study, these carcinomas occurred in older persons, with the antrum being a common site. Observed grossly, growth of the tumors was nodular and massive. Prognosis was poor because of frequent liver metastases. In the cytoplasms of tumor cells, various serum proteins were identified, including AFP, alpha-1 antitrypsin (AAT), alpha-1 antichymotrypsin (ACT), albumin, and prealbumin. Localizations of ferritin, prothrombin, and transferrin were demonstrated with less frequency. Adenocarcinomatous foci were composed of well-differentiated, intestinal-type epithelial cells and often contained carcinoembryonic antigen. These adenocarcinomatous and hepatoid areas were often intermingled with each other. There were extensive venous involvements by tumor cells. The poor prognosis of the tumors may be attributed to these involvements as well as to production of AFP and presence of AAT/ACT, which have immunosuppressive and protease-inhibitory properties, respectively.

Hepatoid adenocarcinoma of the stomach

“…Motoyama et al [26] reported that hepatoid adenocarcinoma was the most frequently observed histological type of AFP-producing gastric cancer. To discriminate between hepatoid adenocarcinoma and nonhepatoid adenocarcinoma of the stomach, the measurement of AFP isoforms is also useful, and the AFP level in the serum of patients with hepatoid adenocarcinona shows a liver-type binding pattern with the lectin concanavalin A (Con-A) [23]. However, Ooi et al [27] reported that this was not significant, because such a liver-type binding pattern was detected in only 20% of AFP-producing tumors.…”

“…The two types sometimes coexisted in a single tumor. Ishikura et al [22,23] proposed the term "hepatoid adenocarcinoma of the stomach" for primary gastric carcinomas characterized histologically by hepatoid differentiation and the production of large amounts of AFP. Motoyama et al [26] reported that hepatoid adenocarcinoma was the most frequently observed histological type of AFP-producing gastric cancer.…”

“…In the literature, 85 cases described by the term "hepatoid adenocarcinoma of the stomach" have been reported, including the present case (Table 1 [22,23,24,26,28,). The average age of the patients was 63.5 years (range, 44-87 years), and the male-to-female ratio was 58 : 25 (the sex was not stated for 2 patients).…”

“…Kodama et al [21] described two histologic types of AFP-producing gastric carcinoma. Later, Ishikura et al [22,23] proposed the term "hepatoid adenocarcinoma of the stomach" for primary gastric carcinomas that are characterized by both hepatoid differentiation and the production of large amounts of AFP. This type of tumor is a relatively rare gastric carcinoma, and is recognized as having a poor prognosis, even if the tumor is diagnosed at an early stage [24].…”

Gene expression profiling with microarray and SAGE identifies PLUNC as a marker for hepatoid adenocarcinoma of the stomach

“…It has been reported that most hepatoid adenocarcinoma cases contain coexistent tubular or papillary adenocarcinoma components within the tumor. 30 All six gastric hepatoid adenocarcinoma cases contained both tubular/papillary adenocarcinoma and hepatoid adenocarcinoma components. out of the six hepatoid adenocarcinoma cases, PLUNC staining was observed in both the hepatoid adenocarcinoma component (Figure 2a and b) and the tubular/ papillary adenocarcinoma component (Figure 2c and d).…”