Abstract
BackgroundAlpha-fetoprotein-producing gastric cancer (AFP-GC) is a relatively rare disease, with a dismal prognosis.Case presentationWe report the case of a patient with long-term survival after surgery for the recurrence of AFP-GC. A 71-year-old man was diagnosed with gastric cancer and underwent distal gastrectomy with D2 lymphadenectomy (pT3N2M0). Pathological examination of the resected specimen revealed AFP-GC. Fifteen years after the gastrectomy, the patient experienced anorexia and was admitted with a mass located at the mesentery of the small intestine. Following a diagnosis of gastrointestinal stromal tumor of the mesentery, a tumor resection with partial small intestine was performed. The final histopathological diagnosis was AFP-GC’s recurrence in the small-bowel mesentery. Two months later, multiple liver metastases were identified, and serum AFP level was found to be extremely high (17,447 ng/mL). Chemotherapy with S-1+CDDP (SP) was initiated for liver metastasis. However, owing to anorexia and fatigue, SP therapy was discontinued following the patient’s request at the end of two courses. A CT scan at 1 month after the discontinuation of chemotherapy did not reveal liver metastasis, and serum AFP level decreased to the normal range. He is alive at present with no re-recurrence and no elevation of serum AFP level at 7 years after the second surgery without any chemotherapy.ConclusionEven if recurrence of AFP-GC is diagnosed, radical resection and chemotherapy are effective, as noted in the present case.
Highlights
Alpha-fetoprotein-producing gastric cancer (AFP-GC) is a relatively rare disease, with a dismal prognosis.Case presentation: We report the case of a patient with long-term survival after surgery for the recurrence of AFP-GC
AFP-GC is associated with poor prognosis because of high rates of liver and lymph node metastases [3, 4]
We present a case of a patient with long-term survival after successful treatment with radical surgery for the solitary metastasis of the mesentery and chemotherapy for the multiple liver metastases of AFP-GC at 22 years after the first gastrectomy
Summary
Alpha-fetoprotein-producing gastric cancer (AFP-GC) is a relatively rare disease, accounting for 1.3–15% cases of gastric cancer [1, 2]. We present a case of a patient with long-term survival after successful treatment with radical surgery for the solitary metastasis of the mesentery and chemotherapy for the multiple liver metastases of AFP-GC at 22 years after the first gastrectomy. The serum AFP level was 3720 ng/mL (normal range < 10 ng/mL) preoperatively and decreased to 8.0 ng/mL after gastrectomy performed 15 years ago. Fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated the presence of an abnormal accumulation of FDG at the mass without any distant metastasis Based on these findings, we suspected a metastatic tumor from gastric cancer at the mesentery of the jejunum and performed a laparotomy. Pathological examination revealed tumor cells with an acidophilic cells with an alveolar growth pattern (Fig. 2) Such observations were comparable with the primary gastric cancer’s pathological features. Seven years after the second surgery, and without any chemotherapy, the patient is alive and well, without any recurrence
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