Abstract
A 68-year-old man was admitted to the hospital because of epigastralgia. Gastrofiberscopye disclosed a 3' type tumor in the lesser curvature of the gastric antrum, and hepatic angiogram demonstrated a hypervascular liver metastasis of the gastric tumor. Laboratory data showed a high carcinoembrionic antigen (CEA) level of 610ng/ml and a normal alpha-fetoprotein (AFP) level. The patient underwent a distal gastrectomy and left bisegmentectomy of the liver with D3 lymph node dissection. Histologically the tumor was hepatoid carcinoma despite the normal AFP level. On postoperative day 42, five metastatic lesions in the liver were detected by computed tomography (CT). CDDP and lipiodol-ADM conjugates were monthly administered via an infuse-A-port based on systemic intravenous therapy with 5-Fu and MTX. Dense, homogenous accumulation of Iipiodol was observed in all metastatic foci on CT, and 2 months later shrinkage of three metastatic lesions and disappearance of two of them were confirmed. Reduction rate of the liver metastasis on CT was 95.3% (Partial response), but histologically, no viable cancer cell was observed in a liver biopsy. Characteristic findings on radiological picture of liver metasatasis of the hepatoid carcinoma was similar to those of hepatocelular carcinoma. From these clinical characteristics, it is suggested that agressive operation and intensive IVR based on systemic chemotherapy for liver metastasis may provide a better prognosis.
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