5 Cases of Gastric Cancers with Extraordinary Liver Metastasis

Michio Maruyama, Takeshi Nagahama, Norihito Kure, Tatsuya Yoshida, Takumi Irie, Masakazu Ebuchi and Fukuji Yamada

Department of Surgery, Tokyo Metropolitan Ohkubo Hospital

We sometimes encounter gastric cancer patients whose initial symptoms and signs are enlargement of the liver and liver dysfunction. We, therefore, studied these primary gastric cancer cases with clinical liver swelling and dysfunction that was due to extensive liver metastases. (MATERIALS AND METHODS) We defined this kind of gastric cancer as "Gastric cancer with extraordinary liver metastasis", and found 5 of these cases out of 215 primary gastric cancer cases in a 5 year period (1.9%). (RESULTS) The median age was 67 years and sex ratio (M/F) was 4/1. In these cases, the enlarged livers measured up to 3-5 f. w.under the costal margin. All cases showed high serum NSE (18-170 ng/ml), and 3 showed high serum AFP (250-27,000 ng/ml). Histological examination of biopsied specimens from all cases revealed poorly differentiated adenocarcinoma with medullary growth pattern. Four cases underwent resection of the stomach. 2 of these showed histological differentiation towards neuroendocrine tumor, 2 towards hepatocelluar carcinoma. All cases were given intrahepatoarterial infusion or intravenous infusion of CDDP and 5FU, and showed high sensitivity to chemotherapy (PR). The volume of liver which had enlarged due to severe liver metastases reduced to normal size. Liver volume reduction rate was 56% (43-67%). Three cases died of cancer after 10, 13 and 18 months from initial chemotherapy treatment, and 2 cases survived for 8 and 18 months. (CONCLUSION) "Gastric cancer with extraordinary liver metastasis" showed neuroendocrine differentiation or hepatocellular differentiation. Histological examination of biopsied specimen from original tumors revealed poorly differentiated adenocarcinoma with medullary growth pattern. NSE or AFP was the specific tumor marker for this type of gastric cancer. These tumors showed high chemosensitivity, which improved survival time. "Gastric carcinoma with extraordinary liver metastasis" exhibits unusual clinical and biological characteristics for a gastric cancer.

Key words
gastric cancer, liver metastasis, chemosensitivity

Reprint requests
Michio Maruyama Department of Surgery, Tokyo Metropolitan Ohkubo Hospital 2-44-1 Kabuki-cho, Shinjuku-ku, Tokyo, 160-8488 JAPAN

Accepted
June 22, 1999

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