Hepatoid adenocarcinoma of stomach: Case report of a rare histological variant

Abstract

Hepatoid adenocarcinoma of the stomach is a rare form of gastric carcinoma with specific clinicopathological features and extremely poor prognosis. Here, we report a case of a 60-year-old male patient who presented in the outpatient department with pain abdomen and constitutional symptoms. Radiological examination revealed a growth involving the antrum of the stomach while the liver and spleen were normal. The serum alpha fetoproteins were 6590 ng/ml. The patient underwent a partial gastrectomy and microscopic examination of the growth showed two types of histological patterns. Majority of the tumor displayed hepatoid differentiation with adenocarcinomatous foci. Periodic acid Schiff positive intracytoplasmic hyaline globules were seen. The tumor was immunohistochemically positive for alpha fetoprotein. The patient underwent radical gastrectomy, received chemotherapy and has been on follow-up for the past 12 months. Though known to be an aggressive neoplasm early diagnosis of hepatoid adenocarcinoma can help improve the prognosis of the disease.

Hepatoid adenocarcinoma of stomach: a morphological curiosity

“…The reported incidence varies from 0.17 to 15 % [2][3][4][5] and is common in elderly males. [2][3][4][5][6] The youngest case was reported in a 12-year-old boy.…”

“…1,5 Hepatoid adenocarcinomas have also been report ed in ot her organs, such as oesophagus, jejunum, colon, rectum, gall bladder, lung, peritoneum, urinary bladder, renal pelvis, pancreas, ovaries, uterus and papilla of vater. 6,8 Preoperative diagnosis is difficult as patients present with symptoms similar to other digestive cancers. 9 Epigast ric pain and generalized fatigue caused by anaemia are common symptoms.…”

“…6,8 The cells are large and polygonal with prominent nucleoli, prominent cell borders, central nuclei and abundant cytoplasm. 6,9 The morphology of tumour foci resembles hepatocellular carcinoma. 8 These tumours show positivity for AFP, carcinoembryonic antigen, alpha 1-antitrypsin and alpha 1-antichymotrypsin on IHC.…”

“…8 These tumours show positivity for AFP, carcinoembryonic antigen, alpha 1-antitrypsin and alpha 1-antichymotrypsin on IHC. 6,8,9 Positive AFP staining on histopathology varies from 73.7% -91.6 %. 4,9 Our case showed the characteristic hepatoid morphology with presence of hyaline globules and the histopathological diagnosis was supported by immunohistochemical findings.…”

Case Series of Gastric Hepatoid Adenocarcinoma

“…또한, 진단 당시 광범위한 혈관 또는 림프관 침윤과 간 전이 등의 진행된 형태를 보여 불량한 예후를 초래한다. 3 복부 컴퓨터 단층촬영(CT)에서 위 전정부에 불규칙한 변연 을 갖는 7.4 cm의 종괴가 관찰되었고, 간(S7)에 1 cm 가량의 저음영 결절이 관찰되었다 (Fig. 1).…”