An autopsy case of AFP-producing gastric carcinoma resembling hepatocellular carcinoma on light microscopy

We experienced an autopsy case of alpha-fetoprotein(AFP)-producing advanced gastric carcinoma with liver metastasis. Microscopically, the tumor was compose by medullary nests of poorly differentiated adenocarcinoma cells. The cells had an exclusively hepatoid pattern characterized by discrete masses, nests, and broad bands, consisting of large eosinophilic epithelial cells and separated by fibrous stroma. Immunohistochemical studies of hepatoid cells yielded a positive reaction for AFP, but negative for CEA. Electron microscopically, tumor cells possess a ductal lumina with abundant microvilli having a central core filaments, and secretory granules in cytoplasma. These findings suggest that the tumor cells differentiated into intestinal direction, irrespective of the appearance of their hepatoid features characterized by light microscopy.     

A case of AFP-producing gastric cancer with hepatic metastases that accompanied early gastric cancer treated effectively by chemotherapy

We report a case of alphafetoprotein (AFP)-producing gastric cancer that accompanied early gastric cancer and was treated effectively by chemotherapy. The patient was a 73-year-old male. A type 1 tumor was observed in the upper gastric body and a 0-IIa tumor was noted on the anterior wall of the lower gastric body. Abdominal CT showed multiple metastatic lesions in the liver. A subtotal gastrectomy was performed, and the pathological examination revealed that the type 1 tumor was positive for AFP and the 0-IIa tumor was negative for AFP. After 5 courses of postoperative administration of S-1, hepatic metastatic lesions disappeared on imaging. The serum AFP level, which had increased to the maximum of 49,660 ng/ml, was normalized. After 60 months, there has been no sign of recurrence. We encountered a case of AFP-producing gastric cancer that accompanied early gastric cancer and was treated effectively by S-1. Various therapies for AFP-producing gastric cancer have been reported; however, a standardized regimen has not been established. Since the concurrence of AFP-producing gastric cancer and tubular adenocarcinoma is rare, and hepatic metastatic lesions disappeared, the case under study is considered to be of interest. Therefore, we report this case with a review of the literature.     

A case of AFP-producing gastric cancer accompanied with testicular tumor

A case of an AFP-producing gastric cancer accompanied with non-epithelial tumor is reported. A 63-year-old man, complaining of an epigastric hunger pain, was admitted to our hospital. Testing revealed that he had an extremely high level serum AFP (12,400 ng/ml) with no abnormality of liver function. A barium ingestion and a subsequent endoscopic examination determined the existence of a Borrmann III type advanced gastric cancer on the lesser curvature, extending from middle corpus to the antrum. Diagnostic imaging did not reveal any metastatic lesion in liver. After a total gastrectomy, the patient's serum AFP level rapidly decreased, followed by a recurrence he developed of a carcinomatous pleuritis and death. On autopsy, an enlargement of the right testis was noticed for the first time. Histologically, it was found to be a malignant, non-epithelial tumor, which proved negative for anti-AFP staining by the ABC method and positive for anti *L-26. On the other hand, the gastric cancer was a poorly differentiated adenocarcinoma with a hepatoid differentiation which was positive for anti-AFP staining and negative for anti-L-26 so it thus was diagnosed as an AFP-producing gastric cancer.     

A case of AFP-producing gastric cancer after curative operation effectively treated with chemotherapies including hepatic arterial infusion therapy

A 63-year-old woman was admitted complaining of epigastralgia. An endoscopic examination revealed a Borrmann type 2 lesion at the greater curvature of the middle third in the stomach. Abdominal computed tomography detected no liver metastasis. The preoperative serum alpha-phetoprotein (AFP) level was elevated to 242.9 ng/ml. 5-fluorouracil (5-FU) was given 200 mg/day for 26 days orally. Distal gastrectomy with D3+ No. 16b1 lymph node dissection, cholecystectomy and hepatic arterial canulation were performed, and mitomycin C 20 mg was injected intravenously during the operation. Immunohistochemical staining of the specimen for AFP by the SAB method was positive in the cancer lesion. After the operation, FP (cisplatin 100 mg on day 1, 5-FU 750 mg on days 1-3) therapy of one course and intrahepatic arterial infusion therapy using adriamycin 10-20 mg every 2 weeks for 7 months were conducted. Moreover, the patient took UFT 400 mg/day for 26 months orally on an outpatient basis as an adjuvant chemotherapy. The only toxicity was neutropenia (grade 3), but it abated without an interruption in the chemotherapy. The AFP level declined gradually, and returned to the normal range 1 month after surgery. The patient is still alive with no sign of hepatic metastasis or recurrence 7 years and 7 months after the gastrectomy.     

A case of alpha-fetoprotein-producing gastric carcinoma with histologic features of embryonal carcinoma

A case of advanced gastric carcinoma in a 75-year-old female with highly elevated serum alpha-fetoprotein (AFP) (9050 ng/ml) is presented. A Borrmann 3 type tumor measuring 7 X 7 cm was located in the gastric antrum and directly invaded up to the radix of the superior mesenteric artery. Neither the preoperative CT scan nor close examination at surgery revealed any evidence of hepatic metastasis. The histological examination showed largely embryonal (atypical-cell) carcinoma. By immunoperoxidase staining, AFP and alpha-1-antitrypsin (AAT) immunoreactivities were identified in some carcinoma cells. Sixteen cases of AFP-producing gastric carcinoma reported in Japan were reviewed.     

AFP阳性胃癌的临床病理特征及治疗策略

甲胎蛋白（AFP）阳性胃癌（AFPGC）因其恶性度高、进展快、易转移、预后差等特点,逐渐在临床上受到重视,被认为是一种特殊类型的胃癌。目前AFPGC的治疗更多的是借鉴普通胃癌,但疗效逊于普通胃癌。故针对此类胃癌,探寻其临床病理特征,特别是分子生物学特征,将对该病的诊断及个体化治疗具有十分重要的意义。本文将对AFPGC的定义、临床特征、分子病理特征及治疗现状等方面的研究进展作一综述。     

Basaloid carcinoma of the lung with bronchiolo-alveolar cell differentiation. A case report.

AIMS: We report a case of pulmonary basaloid carcinoma with bronchiolo-alveolar cell differentiation. PATIENTS AND RESULTS: A 75 year-old presented with a tumor measured 2.0 cm and was located in the periphery of the left upper lobe. Histologically, the lesion consisted of nests of basaloid cells, and lumina and clefts lined by tumor cells with features of mucous cells or type II pneumocytes or with mixed features. CONCLUSIONS: Previously reported basaloid carcinomas of the upper aero-digestive tract and lung have been purported to have an aggressive behavior. The tumor in the present study had features of a histopathological low grade tumor including a low mitotic rate, no tumor necrosis and a growth pattern at the periphery similar to that of bronchiolo-alveolar carcinoma.     

Diffuse intrasinusoidal metastasis of gastric carcinoma to the liver leading to fulminant hepatic failure. A case report

An unusual case of gastric carcinoma with diffuse intrasinusoidal metastasis to the liver (DIML) presenting as fulminant hepatic failure is reported. The patient was a 59-year-old man admitted to the hospital complaining of dysphagia. Seven weeks after performance of total gastrectomy, he developed jaundice and consciousness disturbance and died 4 days later. The surgical material was diagnosed as advanced cancer (poorly differentiated adenocarcinoma) of the stomach and postmortem examination disclosed massive and diffuse infiltration of the tumor cells into the hepatic sinusoids with no grossly detectable metastatic nodules. It is important to be aware that, although uncommon, gastric carcinomas may cause fulminant hepatic failure attributable to DIML. The clinicopathologic features of such cases are detailed and a review of the relevant literature included.     

Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report

BACKGROUNDLiver tumors with dual differentiations [combined hepatocellular carcinoma (HCC) and cholangiocarcinoma] are common. However, liver tumors that exhibit hepatocellular, biliary, and neuroendocrine differentiation are exceedingly rare, with only three previous case reports in the literature. CASE SUMMARYA 65-year-old female with a previous history of hepatitis C and a distant history of low grade, well-differentiated rectal neuroendocrine tumor was found to have two liver lesions in segment 4 and segment 7 on imaging. Serum alpha-fetoprotein and chromogranin A were elevated. Biopsy of the larger lesion in segment 4 revealed a high-grade tumor, with morphologic and immunohistochemical features of a neuroendocrine tumor. Given the previous history of rectal neuroendocrine tumor, imaging investigation, serologic markers, and biopsy findings, metastatic neuroendocrine tumor was considered. Subsequent regional resection of these hepatic lesions revealed the segment 4 lesion to be a HCC with additional biliary and neuroendocrine differentiation and the segment 7 lesion to be a cholangiocarcinoma with neuroendocrine differentiation. Follow-up of the patient revealed disease recurrence in the dome of the liver and metastasis in retro-pancreatic lymph nodes. The patient eventually expired due to complications of chemotherapy.CONCLUSIONHCC cases with additional biliary and neuroendocrine differentiation are exceedingly rare, posing a diagnostic challenge for clinicians and pathologists.     

Myoepithelial hamartoma of the stomach simulating a gastric carcinoma. A case report

Myoepithelial hamartoma is a very rare submucosal tumor of the stomach. Magnus-Alsleben first described 5 cases of this tumor in 1903. More recently (1993) Vandelli et al. published a review of the literature comprising only 33 cases. Histologically, the tumor is characterized by hypertrophic smooth muscle bands surrounding diverse epithelial elements that can be arranged in different ways: as a simple glandular structure, Brunner's gland, pancreatic ducts and occasionally pancreatic acinus. We report a case of myoepithelial hamartoma of the stomach simulating a gastric carcinoma.     

A case of hepatocellular carcinoma associated with ossification. A case report

A 54-year-old man with hepatocellular carcinoma (HCC) of the typical trabecular pattern exhibiting unusual histologic features, both osteoid and bone formations, is reported. The tumor was associated with well-developed cirrhosis; thus, this may be different from mixed hepatic tumors of adults with bone formations because the latter are characterized by their prevalence in noncirrhotic livers and by the formation of myxoid connective tissue. Computed tomography of the current case revealed calcification within HCC.     

An advanced gastric cancer with varied histopathologic features including a choriocarcinoma: report of a case

A 77-year-old male, complaining of epigastralgia, was admitted to hospital. An upper GI series revealed a hemispheric filling defect at the greater curvature of the lower gastric body and two submucosal tumor-like lesions of the antrum. Closer inspection revealed a tumor measuring 60 x 42 mm, with an irregular ulcer, and two submucosal tumor-like lesions with bridging folds, measuring 42 x 28 mm and 20 x 14 mm, respectively. Histologically, the microscopic features in the ulcerated tumor showed a variety of tumor cells with clear PAS-positive cytoplasms and marked atypical nuclei forming glandular structures that predominated. Additionally, a clear cell carcinoma, a papillary adenocarcinoma, a signet-ring cell carcinoma, and a choriocarcinoma were partially seen. Finally, in the submucosal tumor-like lesions, diffuse small tumor cells with scanty PAS-positive cytoplasms without granular structures were seen.     

Carcinosarcoma of the stomach with endocrine differentiation. A case report.

An unusual tumor was observed in a 67-year-old man. Microscopically, the tumor was composed of epithelial cells forming glands (CEA, EMA-positive) and spindle-shaped cells (vimentin-positive). A third component was a cell population ultrastructurally characterized by intracytoplasmic granules surrounded by a membrane; these proved to be chromogranin A-positive in the immunoperoxidase study.     

AFP-producing gastric carcinoma: multivariate analysis of prognostic factors in 270 patients

Serum alpha-fetoprotein (AFP) is sometimes high in patients with primary gastric carcinoma, and there is no comprehensive study on the clinicopathologic characteristics and prognostic factors of AFP-producing gastric carcinoma (AGC). To clarify the variables associated with the survival after gastrectomy for AGC, we reviewed the data of patients with AGC and examined the independent prognostic factors. We studied 270 cases of AGC reported in the Japanese literature from June 1982 to March 2001, together with 1 patient of our own experience. The clinicopathologic findings, including serum AFP level, operative curability, and stage of the disease were examined, and factors associated with survival were determined by multivariate analysis. There were 15 stage I tumors (6%), 50 stage II tumors (19%), 51 stage III tumors (20%), and 145 stage IV tumors (55%). The tumors were characterized by frequent serosal invasion (75%), lymph node metastasis (83%), liver metastasis (33%), stage III or IV disease (75%), and noncurative operation (48%). The survival was influenced by the serum AFP level, tumor size, serosal invasion, lymph node metastasis, and liver metastasis, but the independent prognostic factors were operative curability (curative vs. noncurative) and stage of the disease (I, II vs. III, IV). Although the 5-year survival rate and median survival period in all patients were 22% and 14 months, respectively, those in patients with curative gastrectomy were 42% and 29 months, respectively. The results indicate that operative curability and stage of the disease are factors associated with the survival of patients with AGC. Although tumors are often advanced and complicated with liver metastases, long-term survival can be achieved when patients with stage I or II tumor undergo curative gastrectomy.     

A case report of scirrhous gastric carcinoma diagnosed by staging laparoscopy

The case is a sixty-something man with a complication of epigastric abdominal pain. X-ray and endoscopic examination of upper gastrointestinal tract showed a rigidity of the gastric wall and the presence of giant folds on gastric body and fornix. Scirrhous type of gastric cancer was suspected and gastric forceps biopsy was performed at many points under the retreated endoscopic examinations. However, the histologic findings revealed no malignant features. We performed staging laparoscopy, and by peritoneal washing cytology and biopsy of a nodule of abdominal wall, he was diagnosed with advanced gastric carcinoma with peritoneal dissemination. In conclusion, staging laparoscopy is one of the useful methods for diagnosis and determination of the management of scirrhous type gastric carcinoma.     

A case of AFP-producing gastric cancer resected after efficient S-1/CDDP combination chemotherapy

A 62-year-old male was diagnosed as AFP-producing gastric cancer with lymph node metastases and multiple liver metastases. He was treated with S-1 and CDDP combination chemotherapy. At the end of the first course, both primary and metastatic lesions were remarkably decreased in size, and the serum AFP level was also decreased. The chemotherapy was effective against the cancer and led to a partial response (PR) according to the RECIST guideline. Following the nine months of PR, the primary lesion which had once nearly disappeared, emerged again. Because distant lymph node metastases and liver metastases were considered to have disappeared, distal gastrectomy with D2 lymphadenectomy was performed. The patient received S-1 monotherapy for 6 months after the operation. At present the patient has achieved progression-free survival for 1 year and 3 months after the operation. Though AFP-producing gastric cancer is known for its poor prognosis, combination treatment such as operation or hepatic arterial infusion chemotherapy may improve the prognosis in patients with advanced AFP-producing gastric cancer when systemic chemotherapy is effective.     

AFP-producing gastric cancer--analyses of 17 cases

Serum AFP levels were increased in 17 of 446 patients with primary gastric cancer, No liver metastasis was detected in 11 of them. In all patients who underwent gastrectomy, the post-operative AFP levels were significantly lowered. In patients with recurrence, the increase of AFP levels was detected before the diagnosis of recurrent tumor could be achieved by US or CT. The tumor invasion in most of these patients was graded as ss. Lymph node metastasis was found in all patients. Most tumors were histologically classified as tub 2. The histochemical demonstration of AFP in carcinoma cells of the stomach and metastatic lesions of the liver suggests tht AFP may be produced within cancer cells. The prognosis was generally poor.     

A case of AFP-producing gastric cancer with multiple liver metastases responding to CPT-11 and cisplatin combination chemotherapy

A case of AFP-producing gastric cancer successfully treated with CPT-11 and cisplatin combined therapy is reported together with a review of the literature. A 52-year-old male was admitted with complaints of upper abdominal pain and body weight loss. Gastric cancer with multiple liver metastases was diagnosed based on endoscopy and computed tomography findings. The patient's serum AFP level was 697,100 ng/ml and a biopsy specimen showed AFP-positive tumor cells immunohistochemically. He was treated with a combination chemotherapy consisting of CPT-11 (70 mg/m2) on day 1 and 15, and cisplatin (80 mg/m2) on day 1, repeated every 4 weeks. The primary lesion of the stomach and the liver metastases were remarkably reduced, and the serum level of AFP decreased to 18 ng/ml after 5 cycles of this treatment. No severe side effects were seen during this treatment. This result suggests that combination chemotherapy consisting of CPT-11 and cisplatin may be effective and safe for patients with AFP-producing gastric cancer with multiple liver metastases.