A case of early hepatoid adenocarcinoma of the stomach accompanied by liver metastasis with biliary tumor thrombus

Abstract

An eighty-year-old man complaining epigastralgia, right hypochondral pain and jaundice was referred to the Second Department of Surgery, Kyoto University Hospital because a liver tumor in S5, which was 5cm in diameter was pointed out. HBs antigen, HBc antibody nor HCV antibody was not detected. However an elevated lesion was observed on the posterior wall of gastric antrum. Serum levels of AFP, PIVKA-II and CEA were increased. Subtotal gastrectomy and right lobectomy of the liver was performed. The gastric tumor was T1 (IIa + IIc, sm) carcinoma. Grossly the liver tumor looked whitish, lacked any capsule and was accompanied with a tumor thrombus in intrahepatic biliary duct. The liver tumor was diagnosed as a metastasis from the gastric tumor because histological and immunohistochemical study showed a similarity between gastric and liver tumors which was a poorly differentiated adenocarcinoma composed of cells resembling hepatocellular carcinoma (hepatoid-adenocarcinoma). There are few reports about T1 gastric carcinoma producing AFP and PIVKA-II or about metastatic liver tumor with biliary tumor thrombus. This case is interesting from the viewpoint of rejuvenation of gastric carcinoma and production of carcinoembryonic antigens.