An isolate alpha-fetoprotein producing gastric cancer liver metastasis emerged in a patient previously affected by radiation induced liver disease

Abstract

We report a case of an isolated hepatic neoplasia which originated in a site of the liver previously affected by radiation induced liver disease (RILD) in a patient resected for gastric cancer and referred to us for high serum alpha-fetoprotein (AFP) levels. This case challenged us in distiguishing, even histologically, between primary liver cancer and AFP producing gastric cancer metastasis. Only a panel of immunohistochemical markers allowed the definitive diagnosis of liver metastasis of endodermal stem cell-derived and AFP producing gastric cancer. We discuss the criteria for a differential diagnosis, as well as the possible link between RILD and emergence of liver neoplasia.

Management of gastric cancer with liver metastasis in a pregnant woman

“…While the prognosis for tumors arising from the proximal stomach is bad, the prognosis for tumors arising in the middle third of the stomach may be better after the surgery (8). In gastric cancer, the other situations associated with a bad prognosis are vascular invasion, regional lymphadenopathy and liver metastases (9). In the abdominal ultrasonography of our case the solid nodule had a diameter of 5 cm and largest vascularity was observed in liver, and these findings were thought to indicate metastasis as described in the literature.…”

“…In the abdominal ultrasonography of our case the solid nodule had a diameter of 5 cm and largest vascularity was observed in liver, and these findings were thought to indicate metastasis as described in the literature. In cases of suspected or diagnosed gastric cancer, liver metastases should be considered if a high serum alphafetoprotein (AFP) level has been identified (9). This high level is important in the cases of those who are not pregnant, but in high serum AFP levels increase physiologically during the pregnancy.…”