title: Hepatocellular carcinoma with metastatic gastric cancer simulating Borrmann type 2 and hyperlipidemia.
abstract: A case of hepatocellular carcinoma with metastasis to the stomach and hyperlipidemia as a paraneoplastic syndrome was presented. The patient, a 69-year-old man, was admitted to Kurobe City Hospital with a complaint of epigastralgia. He was diagnosed as having hepatocellular carcinoma by an increased plasma AFP and the abnormalities of hepatic scintigram and abdominal angiography. Endoscopic examination of the stomach revealed an ulcerative lesion suggesting Borrmann type 2 gastric cancer and the gastric mucosal biopsy was interpreted as tubular adenocarcinoma. At autopsy, the liver was enlarged and weighed 4,170 g without liver cirrhosis. Histologic finding of the liver tumor was hepatocellular carcinoma of Edmondson's grade 2 and the gastric tumor with bile production was identical to that of liver tumor. The tumor architecture of the stomach, however, was mixed with trabecular pattern and tubular pattern near the site of gastric mucosa, and was concordant with the findings of gastric mucosal biopsy. Multiple tumor thrombi in the portal system suggested that hepatocellular carcinoma retrogradely metastasized to the stomach through the portal system.
mesh_terms: D000230:Adenocarcinoma / Q000032:analysis; D000368:Aged; D001344:Autopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D013274:Stomach Neoplasms / Q000556:secondary*