A Case of Multiple Gastric Cancer with a Metastatic Liver Tumor Producing Alpha-fetoprotein

Shigeru Tsuyuki, Yoshinori Nio, Kazutomo Inoue, Takayoshi Tobe

First Department of Surgery, Kyoto University Faculty of Medicine

A patient with multiple gastric cancers was studied. The cancers were found to be histologically different and one of them produced Alpha-fetoprotein (AFP). A 76-year-old man was admitted, complaining of epigastralgia and right hypochondralgia. The upper GI series and endoscopy examinations revealed two kinds of lesions, one which was a Borrmann type I lesion located at the cardia and another which was a Borrmann type II lesion located at the angle of the stomach. A CT scan also showed a metastatic lesion in the S4 region of the liver. The serum level of CEA was within normal limits, however the serum AFP level was elevated to 283 ng/ml. A total gastrectomy and R2 removal of the regional nodes, reconstruction using the Roux-en Y method, and segmentectomy of the liver were performed. Histopathological examination revealed that the lesion at the cardia was poorly differentiated adenocarcinoma with diffuse infiltration of lymphcytes and plasma cells and that the lesion at the angle was a moderately differentiated adnocarcinoma. It was also suggested that the liver might have metastasized from the lesion at the angle, because it had the histological features as the lesion. Moreover AFP producing cells were demonstrated in the metastatic liver tumor by the PAP staining method, but they were not found in either the primary lesions or the involved lymph nodes.

Key words
alpha-fetoprotein, mutiple gastric cancer

Reprint requests
Shigeru Tsuyuki First Department of Surgery, Kyoto University Faculty of Medicine
54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606 JAPAN

Accepted
December 12, 1990

To read the PDF file you will need Abobe Reader installed on your computer.