Hepatoid adenocarcinoma of the stomach – proper identification and treatment remain a challenge

Figures & data

Figure 1. Pt #1: Male 48 years of age. Endoscopic view of the gastric tumour located in the fundus.

Figure 2. Time trends of the AFP levels in Pt #1 during the trajectory of his disease.

Figure 3. Pt #1: Coronal multi detector computer tomography(MDCT) shows the gastric tumour (T) in the left hypochondrium with infiltration of the left hemidiaphragma (stapled arrow) and the greater curvature (arrow) of the stomach.

Figure 4. (A) Histopathology of hepatoid carcinoma in the gastric mucosal primary lesion The tumour comprised a mixture of pseudoglandular and hepatoid components. Note the normal glandular structure (arrows) (haematoxylin and eosin staining; original magnification, ×400). (B) Immunohistochemical staining showing intracytoplasmic positivity for AFP (dark brown). Note the non-staining normal glandular structure (arrows) (original magnification, x400).

Figure 5. Pt # 2: Female 81 years of age. (A) Axial MDCT at the time of diagnosis showing the gastric tumour (T) located in the antrum, with lymph nodes (LN) at the lesser curvature. (B) Five months after primary diagnosis: disease progression with liver metastasis (M), tumour and lymph node growth (T) along the lesser curvature, ascites (A) and thrombus in portal veins (white arrow).

Table 1. Patient characteristics and outcomes presented in five recent series.

Author	Study typeTime periodCountry	No. of patientsGenderAge, range (years)	Stage	ElevatedSerum AFP	Endoscopy	Therapy	Survival,Median (range) Months
Lin et al.(2015)	Institution series2001–2010Taiwan	10Male 60%Median 65.5	Lymph node metastasis 70%Distant (liver) metastasis 50%	In 7 of 8 pts (88%)Median 359.2 ng/mL range, 4.3–6,335.6 ng/mL)	BorrmannType III 60%	Surgery in 5 patients (50%) without metastasis – adjuvant chemo therapy in 4 of these	OS 7.2 (0.7–131.8)20% 5-year survival
Xie et al.(2015)	Institution series1999–2014China	19Male 85%Median 61(41–80)	≥ pT3 84.2%pN+ 70.6%Stage IV 15.8%	In 10/12 patients with information(range 2.0–4375 ng/mL)	Localisation:Cardia 42.1%Body 36.8%Antrum 21.1%	Surgery for cure in 85%. Adjuvant chemotherapy offered in 12/16 (75%) resected patients.	OS 12.0DFS 7.0
Yang et al.(2014)	Institution series2005–2012China	31Male 68%Mean 51.2(32–87)	Stage I 22.6%Stage II 19.4%Stage III 32.3%Stage IV 25.7%	87.1% of patients37–6400 ng/mL	BorrmannType I 48%Type II 26%Type III 23%Type IV 3%	Details not available	OS 631.6% 3-year survival
Baek et al.(2011)	Institution series1996–2008Korea	26Male 85%Median 63	Stage IB 12%Stage II 23%Stage III 27%Stage IV 39%	In 7 of 11 patients (64%)Median 208 ng/mL (range 5–4,750,000 ng/mL)	BorrmannType I 9%Type II 22%Type III 48%Type IV 4%EGC* 17%	Gastrectomy with curative intent in 18 patients (69%). Adjuvant chemotherapy offered in 9 of these patients.	17 months RFS after gastrectomy. OS 28 months in Stages I–III and 8 months in Stage IV. OS was 8 months in patients who received palliative chemotherapy.
Zhang et al.(2011)	Institution series1998–2009China	20Males 80%Median 60(40–81)	Stage II 20%Stage III 40%Stage IV 40%	Reliable information not available	BorrmannType II 35%Type III 35%ProtrudetType 15%Unspecified 15%	One gastrectomy, 13 subtotal resections, and 5 palliative resections. 8 patients (40%) received post-op adjuvant chemotherapy.No surgery in one patient	Median OS 12 months, with a 3-year survival rate of 20%, and 27.5% for those surgically treated.

*EGC: early gastric cancer; OS: overall survival; RFS/DFS: relapse-free survival/disease-free survival.