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Moon, Kim, Cheong, Lee, Ryu, and Song: A Case of Hepatic Metastasis of Gastric Hepatoid Adenocarcinoma Mistaken for Primary Hepatocellular Carcinoma
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(4): 262-266.

Published online: 20 October 2012

DOI: https://doi.org/10.4166/kjg.2012.60.4.262

A Case of Hepatic Metastasis of Gastric Hepatoid Adenocarcinoma Mistaken for Primary Hepatocellular Carcinoma

Ji Yoon Moon, Gwang Ha Kim, Jae Hoon Cheong, Bong Eun Lee, Dong Yup Ryu, Geun Am Song

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

Correspondence to: Gwang Ha Kim, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82 -51-240-7869, Fax: +82-51-244-8180, doc0224@pusan.ac.kr

Received 19 August 2011       Revised 30 September 2011       Accepted 30 September 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastric hepatoid adenocarcinoma is a special type of gastric carcinoma, which produces AFP. We report a case of an metastatic gastric hepatoid adenocarcinoma mistaken for primary hepatocellular carcinoma (HCC). A 72 year-old woman was transferred to our hospital for treatment of the hepatic mass. She underwent subtotal gastrectomy for gastric cancer 2 years ago. A year ago, she was diagnosed with hepatic mass and treated with transhepatic chemoembolization under the suspicion of primary HCC in other hospital. The hepatic mass looked like primary HCC on CT, and serum AFP was elevated to 18,735 IU/mL. We did the transhepatic mass biopsy and compared it to the histology of the previous gastric cancer. The results of immunohistochemical staining between them was coincident, and so it was diagnosed as a hepatic metastasis of gastric hepatoid adenocarcinoma.

Keywords: Gastric hepatoid adenocarcinoma, Alpha-fetoproteins, Stomach neoplasms

Figures and Tables

Fig. 1
Endoscopy revealed a protruding tumor with a central ulceration at the anterior wall of the antrum. It was thought to be Borrmann type II advanced gastric cancer.
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Fig. 2
Abdominal CT scan. (A) Arterial phase CT scan showed contrast enhancement of the tumor. (B) Portal venous phase CT scan showed washout of contrast from the tumor.
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Fig. 3
Microscopic findings (H&E, ×200). (A) Stomach resection. Tumor in the stomach showed tubular-moderately differentiated adenocarcinoma. (B) Liver biopsy. Tumor in the liver showed glandular structure with hepatoid differentiation.
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Fig. 4
Immunohistochemistry staining of gastric and liver biopsy specimen (×200). CK20, CK7 and CDX2 were positive in both specimen and CK19 was positive in liver biopsy specimen. Expression of CK20, CK7 and CDX2 were usually seen in gastrointestinal origin and CK20, CK7 and CDX2 negative epithelial neoplasm included primary hepatocellular carcinoma.
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Fig. 5
AFP stain was positive in the liver biopsy specimen (Immunohistochemical stain, ×200).
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Notes

Financial support: None.

Conflict of interest: None.

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