Hepatoid Adenocarcinoma of the Stomach with Liver and Pulmonary Metastases: A Case Report and Literature Review

Abstract

Hepatoid Adenocarcinoma of the Stomach (HAS) is a rare unique subtype of Gastric Cancer (GC) with a low incidence but a high mortality rate. We report a female case of 67-years-old with APF producing hepatoid adenocarcinoma of the gastric antrum with liver and lung metastases. Abdominal CT of the patient showed multiple liver masses, which were considered as metastatic tumors and proved to be adenocarcinoma by pathological examination of a biopsy. The gastroscopy revealed antral ulcer complicated with bleeding. The biopsy results of hepatoid adenocarcinoma were consistent with the results of liver masses. Moreover, α-Fetoprotein (AFP) increased sharply to 86332 ng/mL. Thus, the diagnosis of gastric hepatoid adenocarcinoma with liver metastasis was established. In terms of treatment, liver TACE embolization was performed first, followed by radical gastrectomy and resection of liver tumor. During the operation, multiple small tumors (less than 5cm in diameter) in the liver were treated by radiofrequency ablation. The patient recovered well after surgery, with a rapid decline in AFP. Postoperative CT indicated the presence of bioactive tumors in the liver and new tumors in the lung. Lung puncture pathology suggests tumor metastasis. Liver and lung were treated with radiofrequency ablation and SOX (Oxaliplatin and Tegacil) chemotherapy. There was no significant recurrence 20 months after surgery, and personalized systematic treatment for this patient was effective. Standard treatment for gastric hepatoid adenocarcinoma has not yet been established, and personalized systematic therapy is the preferred treatment.