[Carcinoma hepatoides of the stomach --case report and literature review].
Hepatoid differentiation in neoplastic tumors occurs not only in primary hepatic carcinoma but also in other malignant tumors, especially carcinomas. Stomach is the most frequent site of such tumors. Usually, at the time of diagnosis liver metastases are found and it is difficult to establish what was the primary site of hepatoid-like carcinoma.


METHODS
83-year-old man was admitted to the hospital due to upper gastrointestinal haemorrhage. Beside weight loss (11 kg during the period of 3 months) he did not complain of any symptoms. Urgent gastroscopy revealed in the middle portion of the gastric corpus two ulcers 12 and 3 mm in diameters and just above them polyp 1.5 cm in diameter. The other parts of gastrointestinal tract were normal. Neoplastic infiltration of the whole thickness of the gastric wall was found in the histopathologic examination of the specimens taken from all these lesions. The lesion consisted of the hepatocyte-like cells with the droplets of bile visible among them. Morphological examination and immunohistochemical results (CKMNF+, CKhepatocyte+, Vimentin and CD68 negative) were consistent with very rare hepatoid type of gastric cancer--carcinoma hepatoides. The following investigations (USG, CT) showed tumor in the II, III and IV segments of the liver and thromboses in the left branch of vena porta and middle hepatic vena. The serum level of AFP was high (5837 ng/l). The possibility of gastric infiltration by primary hepatic tumor and primary gastric hepatoides carcinoma were considered in the differential diagnosis.


CONCLUSIONS
Morphological characteristics of primary hepatic carcinoma may be identical with primary gastric hepatoides carcinoma. When the biopsy specimens are very small even immunohistochemical examination does not allow to establish the diagnosis.
Górnicka
Barbara
B
Zakładu Anatomii Patologicznej, Akademii Medycznej w Warszawie.
Ziarkiewicz-Wróblewska
Bogna
B
Muszyński
Jacek
J
Wróblewski
Tadeusz
T
Bogdańska
Magdalena
M
Morton
Marcin
M
Wasiutyński
Aleksander
A
D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D008297:Male; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology