A case Report of Giant Gastric Cancer with Producing of Alpha-fetoprotein and Human Choriogonadotropine

Haruhiko Nagami, Takayoshi Fukuda, Katsuhiro Tamura*, Masahisa Nakagawa*, Tsuyoshi Yamamoto*, Akira Nakase*

Department of Surgery, The Second Izumo City Hospital
*The First Department of Surgery, Shimane Medical University

We experienced a 74-year-old woman with advanced gastric carcinoma of which the components were hepatoid adenocarcinoma coexisting with chorioepithelioma in the stomach. This case was stage IV {P₀, H₁, n₁ (+), sei} carcinoma and total gastrectomy (R₂), distal pancreatectomy and partial transverse colectomy were performed. Histopathological investigation of the surgically removed specimen revealed widespread hepatoid adenocarcinoma with medullary proliferation and, in the fundus, chorioepithelioma which was composed mainly of trophoblasts with synchitiotrophoblastic giant cells, bleeding and necrotic tissues. Immunohistochemical study revealed AFP in the hepatoid adenocarcinoma and hCG in the chorioepithelioma. We speculate that, regarding the histogenesis of the tumor in our case, the development of the gastric carcinoma cells represents a retrodifferentiation of adenocarcinoma cells to the levels of embryonal carcinoma cells and then dysdifferentiation of the embryonal carcinoma cells to both hepatoid adenocarcinoma and chorioepithelioma. The serum AFP level in this patient decreased after surgical removal of the tumor, but she died of progressive proliferated liver metastasis with a significantly increased serum hCG level.

Key words
giant gastric carcinoma, hepatoid adenocarcinoma, chorioepithelioma

Reprint requests
Haruhiko Nagami Department of Surgery, The Second Izumo City Hospital
238 Tiimiyachou, Izumo City, 693 JAPAN

Accepted
September 12, 1990

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