Alpha Fetoprotein Producing Early Gastric Cancer with Metachronous Liver Metastasis : A Report of Two Cases

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AFP-producing early gastric cancer is extremely rare, and its characteristics and prognosis have not yet been clarified. We report two cases of AFP-producing early gastric cancer with metachronous multiple liver metastases after curative resection.<BR>Case 1 : A 53-year-old woman with epigastralgia was found to have a depressive lesion in the middle portion of the stomach by gastroendoscopy. The preoperative serum level of AFP was32 ng/ml. Pylorus -preserving gastrectomy with D1 lymph node dissection was performed. The resected specimen showed a depressive tumor of 18 × 14 mm with histological findings of porl, sm, n0 and positive for AFP staining. Ten months later, the serum AFP level elevated to 70, 520 ng/ml, and liver metastasis was identified. In spite of liver resection, and chemotherapy, she died 22 months after the first operation.<BR>Case 2 : A 52-year-old man with epigastralgia was found to have a depressive lesion in the lower third portion of the stomach by gastroendoscopy. The preoperative serum level of AFP was332 ng/ml. Distal gastrectomy with D2 lymph node dissection was performed. The resected specimen showed a depressive lesion surrounded by slight elevation of 27 × 18 mm. Histological findings were porl, sm, n0 and reactive for AFP staining. An elevated serum AFP level (620 ng/ml) and multiple liver metastases were detected by abdominal CT seven months later and he died 16 months after surgery.<BR>We must keep in mind the high malignant potential of AFP-producing early gastric cancer, and should observe patients carefully using echogram, CT and the serum AFP level.

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