A Case of AFP (alpha-fetoprotein) Producing Gastric Cancer with Hepatic Metastases Showing Marked Improvement by Chemotherapies and Operations

Naonori Takahashi, Shin Teshima and Yasuo Kunii

Department of Surgery, Sendai National Hospital

A 55-year-old man was admitted complaining of epigastralgia. An upper GI series and endoscoic examination revealed a Borrmann type3 lesion at the angle of the stomach. A CT scan and US showed a tumor shadow in the S4, 5 and S8 regions of the liver. The preoperative serum AFP level was high at 1,600 ng/ml. Distal gastrectomy and D1 removal of the rigional nodes were performed. After the operation, intrahepatic arterial infusion therapy using doxorubicin and lipiodol was performed and the AFP level gradually decreased. The liver was partially resected on the 42nd day after the first operation. Pathological findings of the specimens revealed that the lesion at the angle was poorly differentiated adenocarcinoma. It was also suggested that the liver might have metastasized from the lesion at the angle, because it had the histological features of the lesion. Moreover AFP-producing cells were demonstrated in both the primary lesions and the metastatic liver tumor by the PAP staining method. The serum AFP level returned to the normal range 3 months after the hepatectomy. As postoperative chemotherapy, sequential chemotherapy with methotrexate and 5-fluorouracil (MTX/5-FU) was undertaken. The procedure consisted of MTX 70 mg/m² (iv) followed one hour later with 5-FU 500 mg/m² (div). The patient was treated 140 times by MTX/5FU sequential therapy. No adverse drug reaction or clinical laboratory test abnormality due to chemotherapy was observed. The patient is alive without any sign of hepatic metastasis or recurrence, 5.5 years after the hepatectomy.

Key words
AFP-producing gastric cancer, multiple liver metastases, cancer chemotherapy

Reprint requests
Naonori Takahashi Department of Surgery, Sendai National Hospital 2-8-8 Miyagino, Miyagino-ku, Sendai, 983-8520 JAPAN

Accepted
November 13, 1998

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