Hepatoid gastric adenocarcinoma

Spontaneous rupture of metastatic alpha-fetoprotein-producing gastric cancer of the liver

An 80-year-old man was admitted to our hospital because of the rupture of the liver. Laboratory data showed iron-deficiency anemia, although there was no liver dysfunction. A computed tomography scan showed large liver tumor with intraperitoneal hemorrhage, and since a serum level of α-fetoprotein (AFP) was extremely high, we initially suspected a rupture of hepatocellular carcinoma (HCC). Transarterial embolization was performed to stop bleeding from the tumor, followed by an endoscopic examination that revealed advanced gastric cancer. Histological analysis revealed that both the gastric and the hepatic tumors were moderately to poorly differentiated adenocarcinoma, as well as that both tumors were immunohistochemically positive for AFP. Finally, we diagnosed AFP-producing gastric cancer associated with liver metastasis. Rupture of metastatic liver cancer is rare, and accordingly, distinction from HCC is important, particularly for the cases of AFP-producing gastric cancer.

Spontaneous rupture of metastatic alpha-fetoprotein-producing gastric cancer of the liver. Hepatol Int. 2008;2:258-261. [PMID: 19669313 DOI: 10.1007/s12072-0]

An 80-year-old man was admitted to our hospital because of the rupture of the liver. Laboratory data showed iron-deficiency anemia, although there was no liver dysfunction. A computed tomography scan showed large liver tumor with intraperitoneal hemorrhage, and since a serum level of alpha-fetoprotein (AFP) was extremely high, we initially suspected a rupture of hepatocellular carcinoma (HCC). Transarterial embolization was performed to stop bleeding from the tumor, followed by an endoscopic examination that revealed advanced gastric cancer. Histological analysis revealed that both the gastric and the hepatic tumors were moderately to poorly differentiated adenocarcinoma, as well as that both tumors were immunohistochemically positive for AFP. Finally, we diagnosed AFP-producing gastric cancer associated with liver metastasis. Rupture of metastatic liver cancer is rare, and accordingly, distinction from HCC is important, particularly for the cases of AFP-producing gastric cancer.

Hepatoid adenocarcinoma of the stomach

A 54-year-old man presented to his doctor with hematemesis and was found at endoscopy to have an ulcerated lesion in his stomach. A computed tomography scan was performed and revealed a mass in the fundus of the stomach. Multiple other lesions were identified in the liver, lungs, retroperitoneal space, and mesentery. Gross examination showed two separate gastric lesions containing nests and single cells with mucin intermixed with sheets of tumor cells with abundant eosinophilic cytoplasm invading throughout the wall of the stomach. Immunohistochemical studies were performed and the cells were positive for hepatocyte, MOC 31, cytokeratin A1/A3, and CK 7, and were negative for CK 20, alpha-fetoprotein, and thyroid transcription factor. The histologic features together with the immunohistochemical findings were diagnostic of a hepatoid adenocarcinoma of the stomach. Hepatoid adenocarcinoma is a rare tumor associated with a very poor prognosis. Immunohistochemical studies may help to identify the characteristic features of hepatoid differentiation and prevent mistaking this tumor for other types of carcinoma.

alpha-Fetoprotein-producing adenocarcinoma of the pancreas presenting focal hepatoid differentiation

We report a rare case of pancreatic carcinoma producing alpha-fetoprotein (AFP), showing focal hepatoid differentiation in metastatic lymph nodes. A 65-yr-old female was admitted because of abdominal pain. The serum AFP was measured at 16,170 ng/mL. Radiological examinations revealed a mass measuring 6 cm in diameter in the body and tail of the pancreas. A right supraclavicular lymphadenopathy was found and biopsied. Light microscopy showed a tumor consisting of a portion of a hepatoid area and well-differentiated adenocarcinoma, which was suggestive of a hepatoid adenocarcinoma. Immunohistochemical analysis showed that the tumor cells expressed AFP, alpha 1-antitrypsin (AT) and albumin. Although the pathological diagnosis of the primary pancreatic tumor was not obtained, this appears to be the first case of hepatoid adenocarcinoma of the pancreas.

Carcinoma of the stomach with hepatocyte differentiation (hepatoid adenocarcinoma)

A case of hepatoid adenocarcinoma of the stomach is reported, and the literature is reviewed. The stomach is one of the most common sites in which hepatoid adenocarcinomas have been detected. Of the 59 cases reviewed from the literature (including the current case), a 2:1 male predominance was noted, and the serum alpha-fetoprotein level was almost always increased. All patients were adults, and most had evidence of metastases at the time of resection. Prognosis seems less favorable than that associated with the more common intestinal type of adenocarcinoma of the stomach. Hepatoid adenocarcinomas typically show periodic acid-Schiff-positive, diastase-resistant intracytoplasmic globules, which are demonstrated to be positive with antibodies to alpha-fetoprotein. The tumor cells resemble liver cells, and rare cases, including our own, have evidence of bile production. In our case, messenger RNA for albumin, unique to liver cells, was demonstrated by in situ hybridization of the tumor cells.

Hepatoid adenocarcinoma of the lung: report of a case of an unusual alpha-fetoprotein-producing lung tumor

We report on a rare tumor of the lung characterized by its morphologic hepatoid features and alpha-fetoprotein production. This unusual neoplasm arose in the left lung of a 36-year-old man in whom clinical and radiologic examinations did not reveal any other tumor. The serum level of alpha-fetoprotein was measured at 6,090 ng/mL and was parallel to the evolution of the tumor. Despite treatment, the patient died 7 months after the diagnosis. The microscopic appearance of the tumor was the same as observed in hepatocarcinoma and hepatoid adenocarcinoma of the ovary or the stomach, with a tubular, papillary, or trabecular pattern. Periodic acid-Schiff-positive hyaline globules were numerous, and tumor cells showed immunohistologic positivity for alpha-fetoprotein and carcinoembryonic antigen. This lung adenocarcinoma was first described by Ishikura et al. in 1990 and was named hepatoid lung adenocarcinoma. Like the rare hepatoid carcinoma of the gallbladder, the pancreas, the ampulla of Vater, the renal pelvis, and the bladder, the exact histogenesis and the prognosis of this type of lung tumor are not yet known.

Hepatoid Gastric Carcinoma. A Case Report

Alpha-fetoprotein (AFP) is normally produced by primary hepatic neoplasms and germ cell tumors. There have, however, been reports of its production in cases of gastrointestinal tract adenocarcinoma. Gastric hepatoid carcinomas constitute a clinicopathological entity of recent acquisition and have certain common characteristics, which include the presence of hepatoid foci and frequent liver metastases, even in cases of early gastric cancer, and increasing serum AFP levels. In this study the case of one patient who underwent gastric resection and presented clinical, humoral, histological and immunohistochemical characteristics typical of hepatoid gastric carcinoma is reported. More biological studies, as well as precise criteria for pathological definition and therapy, are still necessary for a better understanding of this pathology.

Alphafetoprotein-producing gastric adenocarcinoma

We report a rare gastric tumour characterized morphologically by its hepatoid features and alpha-fetoprotein production and which presented clinically with gastric haemorrhage. Gastric fibroscopy showed a bleeding tumour of the antrum. The microscopic appearance of the tumor showed two different patterns. The most extensive presented hepatoid features. The second pattern showed undifferentiated features. The tumour cells showed immunohistochemical positivity for alphafetoprotein, EMA and p53 protein; 37% were aneuploid with a DNA index of 1.46. The serum level of alphafetoprotein was not measured before the gastrectomy but after ten days it was elevated at 1070 ng/ml. The patient died 6 months after the admission. This case provides, for the first time, information on the DNA content and the p53 expression of this unusual and aggressive variant of gastric adenocarcinoma.

Alpha-fetoprotein producing undifferentiated carcinoma of the bladder

We report on a rare primary undifferentiated carcinoma of the bladder producing alpha-fetoprotein in a woman. Definitive features included an aggressive, invasive and rapidly growing tumor with a hepatoid carcinomatous lesion on histological examination. Histopathological findings suggested that the multipotent transitional cell induces production of alpha-fetoprotein. The association of an aggressive tumor with the ability to produce this antigen suggests a possible benefit in measuring serum alpha-fetoprotein levels and examining histological sections for its expression in primary undifferentiated carcinoma of the bladder. Further study may indicate radical cystectomy when the resected specimen produces alpha-fetoprotein, particularly if tumors appear to be aggressive and highly vascularized as in our case.

Hepatoid adenocarcinoma of the stomach. A clinicopathologic and immunohistochemical analysis

BACKGROUND

The clinicopathologic and immunohistochemical features of the primary gastric hepatoid adenocarcinomas still remain unclear.

METHODS

The authors evaluated 28 hepatoid adenocarcinomas (HC) of the stomach on the basis of characteristic histologic features resembling hepatocellular carcinoma, which were selected from the 7200 cases of primary gastric carcinoma in their files. Additionally, 22 alpha-fetoprotein (AFP)-positive adenocarcinomas without hepatoid features (APC) were also selected.

RESULTS

The HC cases fell into the following two groups: HC with AFP-positive tumor cells (Group 1; 15 cases) and HC without AFP-positive cells (Group 2; 13 cases). Histologically, the glycogen granules and hyaline globules were common features in HC. The incidence of a venous invasion of HC (Groups 1 and 2) was higher than that of APC (Group 3). There were no significant differences among the three groups regarding clinical features, macroscopic features, and the incidence of lymphatic permeation. An immunohistochemical study showed that HC had differentiation into various directions. As for the advanced carcinomas, the 5-year survival rates of patients with HC (Groups 1 and 2) and those with APC (Group 3) were 11.9% (21.4%, 8.3%) and 38.2%, respectively. The prognosis of Group 1 was similar to that of Group 2, but was poorer than that of Group 3.

CONCLUSIONS

The findings suggested that HC, as shown by its characteristic histologic features, had a poor prognosis whether producing AFP or not, and that HC should therefore be distinguished from AFP-positive carcinoma without hepatoid features.

Hepatoid carcinoma of the stomach

A patient with primary gastric carcinoma exhibiting hepatoid differentiation is described. The tumor itself was not associated with a high serum alpha-fetoprotein, but the cells stained positive for alpha-fetoprotein and alpha-1 antitrypsin. The patient underwent a total gastrectomy and wedge excision of the liver metastasis. The presence of metastatic hepatoid adenocarcinoma of the stomach should be considered in a patient who, during surgery for a primary gastric carcinoma, is found to have a liver metastasis that is diagnosed by frozen-section biopsy as a hepatoma. Because of lymph node and liver metastasis, prognosis appears to be poor for such patients.