title: Hepatoid adenocarcinoma of the stomach: an unusual case of elevated alpha-fetoprotein with prior treatment for hepatocellular carcinoma.
abstract: Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-year-old man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alpha-fetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymph-node metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Ahn
authors.forename: Ja Ryong
authors.initials: JR
authors.lastname: Jeon
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Yoo
authors.forename: Taek Kyu
authors.initials: TK
authors.lastname: Park
authors.forename: Cheol Keun
authors.initials: CK
authors.lastname: Park
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D005472:Fluorouracil / Q000627:therapeutic use; D005773:Gastroscopy; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D012008:Recurrence; D017640:Silicates / Q000627:therapeutic use; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary; D014025:Titanium / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D017640:Silicates; D000509:alpha-Fetoproteins; C103828:titanium silicide; D014025:Titanium; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Hepatocellular carcinoma; Hepatoid adenocarcinoma; Metachronous; Stomach