3232 Metastatic Adenocarcinoma of the Stomach With Elevated AFP but Normal CEA in a White American Patient

Abstract

INTRODUCTION: Globally, gastric cancers are the fourth most common cancer and second most common cause of cancer-related mortality. Alpha-fetoprotein (AFP) is a glycoprotein that is typically found during the process of fetal development. It has a very short half-life and is cleared from the body rapidly after birth. Increasing concentration of this glycoprotein in adult life is associated with malignancy of the liver, yolk sac tumor of testis, mediastinum and other conditions like hepatitis and cirrhosis of the liver. Alpha-fetoprotein (AFP) producing gastric adenocarcinoma is very rare. Its incidence is reported to be only 2.7 to 8% amongst all gastric cancers. Most of the cases of gastric adenocarcinoma producing AFP reported in the literature are from Asia. It is a very aggressive tumor with an estimated survival time of less than one year because of its rapid spread to lymph nodes and liver. CASE DESCRIPTION/METHODS: In this case report, we present a unique case of AFP producing gastric adenocarcinoma in a white American patient. AFP producing gastric adenocarcinoma have elevated levels of both AFP and carcinoembryonic antigen (CEA). Our case had closer to normal levels of CEA despite very high levels of AFP. The levels of AFP in our patient did not correlate with the size, stage or prognosis of the tumor. Despite the presence of liver metastasis, our case had a very good prognosis so far and had received up to six cycles of chemotherapy without any complications. DISCUSSION: In this case report, we have discussed the histological subtypes of AFP producing gastric adenocarcinomas. We have emphasized the use of immunohistochemical markers in the differentiation of primary hepatocellular carcinoma from AFP producing gastric adenocarcinoma. We have also discussed up to date treatment options, prerequisites for treatment, monitoring of treatment response and prognosis of AFP producing gastric adenocarcinomas in detail in this case report.