title: Solitary AFP- and PIVKA-II-producing hepatoid gastric cancer with giant lymph node metastasis.
abstract: A 61-year-old man was admitted to our hospital because of abdominal pain and an abdominal mass. The patient had anemia and elevated serum alpha-fetoprotein (AFP) (9630ng/mL) and PIVKA-II (91mAU/mL) levels. Roentgenographic examination revealed an extra-gastric tumor in the upper abdomen, and gastroscopy revealed Bormann type 2 gastric cancer in the lower portion of the stomach. The preoperative diagnosis was synchronous gastric cancer and hepatocellular carcinoma (HCC), and surgery was performed. The extra-gastric tumor appeared to be an extra-hepatically growing HCC because the tumor was fed by vessels ramifying from the umbilical portion of the liver. Distal gastrectomy with resection of the extra-gastric tumor was performed, and histological examination of the resected specimen revealed that the gastric cancer was an AFP-producing hepatoid gastric adenocarcinoma and that the extra-gastric tumor was a lymph node metastasis. AFP-producing hepatoid gastric adenocarcinoma tends to metastasize to the regional lymph nodes and form a giant tumor. A giant tumor in the upper abdomen associated with gastric cancer may therefore be a clinical manifestation of AFP-producing hepatoid gastric adenocarcinoma.
authors.affiliation: Second Department of Surgery, Dokkyo University School of Medicine, Tochigi, Japan. cch46590@nyc.odn.ne.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Iso
authors.forename: Tokihiko
authors.initials: T
authors.lastname: Sawada
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Shimoda
authors.forename: Kyu
authors.initials: K
authors.lastname: Rokkaku
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohkura
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000792:Angiography / Q000379:methods; D015415:Biomarkers / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis*; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011498:Protein Precursors / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin