Hepatoid adenocarcinoma of the stomach: an unusual case of elevated alpha-fetoprotein with prior treatment for hepatocellular carcinoma
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-yearold man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alphafetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymphnode metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP. (Clin Mol Hepatol 2013;19:173-178)
Abstract
Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-yearold man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alphafetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymphnode metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP. (Clin Mol Hepatol 2013;19:173-178)
참고문헌 (17)
- Terracciano LM, "Hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma: an immunohistochemical and molecular study of eight cases", Am J Surg Pathol, 27, pp.1302~1312 (2003)
- Bourreille J, "Existence of alpha feto protein during gastric-origin secondary cancer of the liver", Presse Med, 78, pp.1277~1278 (1970)
- Metzgeroth G, "Hepatoid adenocarcinoma - review of the literature illustrated by a rare case originating in the peritoneal cavity", Onkologie, 33, pp.263~269 (2010)
- Ishikura H, "Gastrointestinal hepatoid adenocarcinoma: venous permeation and mimicry of hepatocellular carcinoma, a report of four cases", Histopathology, 31, pp.47~54 (1997)
- Lin CW, "Hepatoid adenocarcinoma of the stomach with liver metastasis mimicking hepatocellular carcinoma: a case report", Cases J, 2, pp.6317~ (2009)
- Morinaga S, "Primary hepatocellular carcinoma and hepatoid adenocarcinoma of the stomach with liver metastasis: an unusual association", Jpn J Clin Oncol, 26, pp.258~263 (1996)
- Lauffer JM, "Hepatocellular carcinoma and hepatoid adenocarcinoma of the stomach", Dig Surg, 14, pp.557~561 (1997)
- Ganjei P, "Histologic markers in primary and metastatic tumors of the liver", Cancer, 62, pp.1994~1998 (1988)
- Gitlin D, "Synthesis of -fetoprotein by liver, yolk sac, and gastrointestinal tract of the human conceptus", Cancer Res, 32, pp.979~982 (1972)
- Ishikura H, "Aizawa M. An AFP-producing gastric carcinoma with features of hepatic differentiation. A case report", Cancer, 56, pp.840~848 (1985)
- Inagawa S, "Hepatoid adenocarcinoma of the stomach", Gastric Cancer, 4, pp.43~52 (2001)
- Cappetta A, "Hepatoid adenocarcinoma of the colon: what should we target?", Pathol Oncol Res, 18, pp.93~96 (2012)
- 서경원, "간세포양 위선암의 임상적 고찰", 대한외과학회지, 67(2), pp.118~123 (2004), 대한외과학회
- Nagai E, "Hepatoid adenocarcinoma of the stomach. A clinicopathologic and immunohistochemical analysis", Cancer, 72, pp.1827~1835 (1993)
- Yachnin S, "The immunosuppressive properties of alpha-fetoprotein: a brief overview", Ann N Y Acad Sci, 417, pp.105~107 (1983)
- Redelman D, "The mechanism of cell-mediated cytotoxicity. I. Killing by murine cytotoxic T lymphocytes requires cell surface thiols and activated proteases", J Immunol, 124, pp.870~878 (1980)
- Kodama T, "Production of alpha-fetoprotein, normal serum proteins, and human chorionic gonadotropin in stomach cancer: histologic and immunohistochemical analyses of 35 cases", Cancer, 48, pp.1647~1655 (1981)