A Case of Difficult Diagnosis of Alpha-Fetoprotein-Producing Early Gastric Cancer with Liver Metastasis, Which Achieved Complete Resection Metachronously

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  • 診断に難渋したAFP産生早期胃癌肝転移を異時性に治癒切除した1例

Abstract

<p>A 72-year-old male was receiving follow-up of an intraductal papillary mucinous neoplasm. Abdominal CT showed a space-occupying lesion on the liver at S4, and findings similar to hepatocellular carcinoma were identified on EOB-MRI. The patient was diagnosed with hepatocellular carcinoma based on increases in serum AFP and PIVKA-II, and underwent partial liver resection of S4. Pathological findings revealed mainly adenocarcinoma, but diagnosis of intrahepatic cholangiocarcinoma, rather than hepatocellular carcinoma, was made by immunostaining. Five months after surgery, serum AFP and PIVKA-II increased again. Upper endoscopy detected a Borrmann type 1 tumor on the lesser curvature of the stomach, and a biopsy revealed adenocarcinoma. Laparoscopic distal gastrectomy was performed due to suspected gastric cancer or intrahepatic cholangiocarcinoma with gastric metastasis. Pathological findings showed adenocarcinoma similar to hepatectomy specimens, and severe venous invasion was observed. A definitive diagnosis of AFP-producing gastric cancer with liver metastasis was made because immunostaining with an anti-AFP antibody was positive for the liver and stomach. To the best of our knowledge, this is the first report of a metastatic tumor that grew and was removed prior to a primary tumor.</p>

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