SlideShare une entreprise Scribd logo
1  sur  4
Télécharger pour lire hors ligne
Journal of Biology, Agriculture and Healthcare                                             www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol 1, No.4, 2011




Hepatoid Adenocarcinoma of the Stomach – a rare histology of

     Gastric Adenocarcinoma in an adolescent: a case report.
            Shyam Sharma1* Krishnangshu Bhanja Choudhury1 Ramesh Kothari1 Anup Majumdar1
     1. Department of Radiotherapy, IPGME&R, Kolkata
* Email of corresponding author: sharma.shyam123@gmail.com


Abstract
Hepatoid adenocarcinoma is a rare subtype of extra-hepatic adenocarcinoma generally characterized by
hepatocellular carcinoma like foci in the background of adenocarcinoma. Stomach is the most frequent site
where hepatoid adenocarcinoma occurs, although it has been described in many other organs. We describe a
case of 16 years old adolescent girl who was diagnosed as a case of “hepatoid adenocarcinoma of stomach’,
an unlikely presentation at this young age.
Keywords: Hepatoid adenocarcinoma, stomach, adolescent.

1. Introduction:
Gastric adenocarcinoma is a malignant epithelial tumor, originating from glandular epithelium of the
gastric mucosa. Hepatoid adenocarcinoma (HAC) is a type of extra-hepatic adenocarcinoma, which shows
a striking morphologic similarity to hepatocellular carcinoma (Gao et al. 2007). It is generally
characterized by adenocarcinomatous and hepatocellular carcinoma (HCC)-like foci. This variant of
adenocarcinoma has been demonstrated to be an alpha-fetoprotein (AFP)-producing carcinoma arising in
extra hepatic organs, and it mimics hepatocellular carcinoma in morphological and functional terms. Alpha-
fetoprotein (AFP) is a fetal serum protein produced by fetal liver and yolk sac cells, and by some fetal
gastrointestinal cells. After birth, the levels of the protein in serum rapidly decrease.


2. Case report:
A 16 years old adolescent girl presented with aggravating abdominal pain for 2 months. She had history of
repeated vomiting, aggravated by food intake for last three months, and anorexia, fatigue and unexplained
weight loss of ten kilograms over the same duration. The initial ultrasonography was unremarkable with no
focal defects seen in liver or abdominal lymphadenopathy. The upper gastrointestinal endoscopy revealed a
circumferential mass lesion at the gastric antrum occluding the lumen. The biopsies from the antral growth
showed histological features of fragmented bits of ulcero-necrotic slough, granulation tissue and acute
inflammatory exudates invaded by several atypical cells with pleomorphic hyperchromatic nuclei, irregular
nuclear membrane and prominent nucleoli; features highly suggestive of a poorly differentiated malignant
lesion. Tumor marker (CEA and CA19-9) serum levels were normal. Based on this report the patient
underwent a distal gastrectomy with dissection of sixteen lymph nodes and biopsy of omental tissue. The
stomach showed a large tumour of nine centimeters in its greatest axis, with histology showing features of
“polygonal cells arranged in solid nest, with scattered large multinucleated giant cells, and well
differentiated papillary pattern with clear cytoplasm – suggestive of Hepatoid Adenocarcinoma”. [Figure 1]
The carcinoma had infiltrated the muscle coat and had extended into the serosa. The surgical lines of
resection were free of lesion. Four out of sixteen lymph nodes were positive for metastasis. The omental
tissue did not show any metastasis. The tumour was immunopositive for cytokeratin and Alpha-fetoprotein
(AFP) [Figure 2] and negative for C-kit, CD 34, Desmin, SMA and S-100 protein. The postoperative AFP
was elevated measuring 5090ng/ml. A post-operative CT scan showed multiple liver metastases in both

                                                   27
Journal of Biology, Agriculture and Healthcare                                                www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol 1, No.4, 2011


lobes with more on right lobe and portal lymphadenopathy. The patient underwent palliative chemotherapy
of six cycles comprising of docetaxel, cisplatin and 5fluorouracil.


3. Discussion:
Stomach cancer is the fourth most common cancer worldwide with 930,000 cases diagnosed in 2002
(Parkin et al. 2005). The studies show that less than 5% of stomach cancers occur in people less than 40
years of age with 81.1% of that 5% in the age-group of 30 to 39 and 18.9% in the age-group of 20 to 29
(Simsa et al. 2004). The overwhelming pathological variety of gastric carcinoma is adenocarcinoma found
in 90% of cases.
Ishikura et al. proposed the term “hepatoid adenocarcinoma of the stomach” for primary gastric carcinomas
characterized histologically by hepatoid differentiation and the production of large amounts of AFP
(Ishikura et al. 1985). This unique histological hepatoid adenocarcinoma has also been reported in the lung,
pancreas, uterus and ovary (Okunaka et al. 1992; Yamada et al. 1994; Itoh et al. 1992; McIntire et al.
1975). The tumor is immunohistochemistry positive is for cytokeratin and Alpha fetoprotein and negative
for C-kit, CD 34, Desmin, SMA and S-100 protein.
There has been mention of case reports of "hepatoid adenocarcinoma of the stomach" in the literature. In
the literature, 86 cases described by the term “hepatoid adenocarcinoma of the stomach” have been
reported, including the present case. In 2001, Inawaga et al revised all these cases and published a report
with the main clinical characteristics of this pathological variety (Inagawa et al. 2001). The average age of
the patients was 63.5 years (range, 44–87 years), and the male-to-female ratio was 58:25 (the sex was not
stated for 2 patients). In most of these patients, the tumors occurred mainly at the antrum (60.2%). The
average serum AFP level was 51130.1 ng/ml (range, less than 1.0–700000ng/ml); that is, much higher than
normal. Although there were no major symptoms sufficient to allow diagnosis of this type of cancer,
epigastric pain and general fatigue because of anemia, were the most common symptoms. The average
maximal tumor diameter was 6.5cm (range, 1.6–14.0cm). Most cases also had metastatic disease to the
lymph nodes or liver.
Furthermore, most of the patients died within 2 years of surgery, despite systemic chemotherapy having
been administered in several patients. These reports suggest that even early stage hepatoid adenocarcinoma
has an extremely poor prognosis, because of the frequent occurrence of liver and/or lymph node
metastases (Nagai et al. 1993; Chang et al. 1991). However, the reasons for the poor prognosis are not
clearly understood. Nagai et al. reported that hepatoid adenocarcinoma had a poor prognosis compared
with that for AFP-producing non-hepatoid adenocarcinoma (Nagai et al. 1993). One possibility is that
hepatoid adenocarcinoma produces AAT and/or ACT as well as AFP. AAT and ACT have
immunosuppressive and protease-inhibiting properties that enhance invasiveness [Redelman & Hudig
1980; Pasternack & Eisen 1985). Also, AFP has a suppressive effect on lymphocyte transformation. In
addition, Koide et al. have reported that AFP-producing gastric cancer has high proliferative activity, weak
apoptosis, and rich neovascularization (Koide et al. 1999). Furthermore, as Chang et al. have reported,
even if no metastasis is present preoperatively, liver metastasis can occur within a year after surgery, and,
thus, close observation and long-term follow-up of patients are required (Chang et al. 1991).
The management of this special subtype has still not clearly been demarcated with majority of patients
detected in metastatic stage requiring palliative chemotherapy with docetaxel, doxorubicin, cisplatin,
capecitabine, irinotecan and 5-fluorouracil in various combinations (Van Cutsem et al. 2006; Dank et al.
2008). The outcome of the subtype is poor for all stages of disease.
In conclusion, we report a rare case of hepatoid adenocarcinoma of the stomach, diagnosed in an adolescent
patient with well defined clinicopathological features. The only hope for curative treatment in this rare
variety of tumour is early diagnosis and administration of novel chemotherapeutic drugs for better disease
control.


                                                    28
Journal of Biology, Agriculture and Healthcare                                                 www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol 1, No.4, 2011


References
Gao YB, Zhang DF, Jin XL, Xiao JC. (2007), “Preliminary study on the clinical and pathological relevance
of gastric hepatoid adenocarcinoma”, Journal of Digestive Diseases 8, 23-28.
Parkin DM, Bray F, Ferlay J, Pisani P. (2005), "Global cancer statistics, 2002". CA: a Cancer Journal for
Clinicians 55(2), 74–108.
Simsa J, Leffler J, Hoch J, Linke Z, Pádr R. (2004), "Gastric cancer in young patients--is there any hope for
them?", Acta Chirurgica Belgica 104 (6): 673–6.
Ishikura H, Fukasawa Y, Ogasawara K, Natori T, Tsukada Y, Aizawa M. (1985), “An AFP- producing
gastric carcinoma with features of hepatic differentiation: a case report”, Cancer 56, 840–8.
Okunaka T, Kato H, Konaka C, Yamamoto H, Furukawa K. (1992), “Primary lung cancer producing alpha-
fetoprotein”, Ann Thorac Surg 53, 151-152.
Itoh T, Kishi K, Tojo M, Kitamura M, Kinoshita Y, Inatome T. (1992), “Acinal cell carcinoma of the
pancreas with elevated serum alphafetoprotein levels: a case report and a review of 28 cases reported in
Japan”, Gastroenterology Japan 27, 785-791.
Yamada K, Fujioka Y, Ebihara Y, Kiriyama I, Suzuki H, Akimoto M. (1994), “Alpha-fetoprotein-producing
undifferenciated carcinoma of the bladder”, Journal of Uroology 152, 958-960.
McIntire KR, Waldmann TA, Moertel CG, Go WLW. (1975),“Serum α-fetoprotein in patients with
neoplasms of gastrointestinal tract”. Cancer Research 35, 991-996.
Inagawa S, Shimazaki J, Hori M, Yoshimi F, Adachi S, Kawamoto T,Fukao K, Itabashi M. (2001),
“Hepatoid adenocarcinoma of the stomach:case report”, Gastric Cancer 4(1), 43-52.
Nagai E, Ueyama T, Yao T, Tsuneyoshi M. (1993), “Hepatoid adenocarcinoma of the stomach”, Cancer
72,1827–35.
Chang YC, Nagasue N, Abe S, Kohno H, Kumar DD, Nakamura T. (1991), “á-Fetoprotein-producing early
gastric cancer with liver metastasis: report of three cases”, Gut 32, 542–5.
Redelman D, Hudig D. (1980), “The mechanism ot cell-mediated cytotoxicity. I. Killing by murine
cytotoxic T lymphocytes requires cell surface thiols and activate proteases”, Journal of Immunolology 124,
870–8.
Pasternack MS, Eisen HN. (1985), “A novel serum esterase expressed by cytotoxic T lymphocytes”, Nature
314, 743–5.
Koide N, Nishio A, Igarashi J, Kajikawa S, Adachi W, Amano J. (1999), “á-Fetoprotein-producing gastric
cancer: histochemical analysis of cell proliferation, apoptosis, and angiogenesis”, American Journal of
Gastroenterology 94, 1658–63.
Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M,
Chao Y, Voznyl E, Risse ML, Ajani JA. (2006), “V325 Study Group: Phase III study of docetaxel and
cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric
cancer: A report of the V-325 Study Group”, Journal of Clinical Oncology 24, 4991-7.
Dank M, Zaluski J, Barone C, Valvere V, Yalcin S, Peschel C, Wenzcl M, Goker E, Cisar L, Wang K, Bugat
R. (2008), “Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic
acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced
adenocarcinoma of the stomach or the esophagogastric junction”, Annals of Oncology 19, 1450-7.




                                                     29
Journal of Biology, Agriculture and Healthcare                                         www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol 1, No.4, 2011




Figures:




Figure 1. Gastric biopsy of the distal gastrectomy specimen 400x hematoxylin eosin staining




Figure 2. The gastric biopsy was strongly immnuopositive for AFP




                                                30

Contenu connexe

Tendances

MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)
MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)
MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)European School of Oncology
 
Innovations in Pancreatic Cancer: A Reason to Hope
Innovations in Pancreatic Cancer: A Reason to HopeInnovations in Pancreatic Cancer: A Reason to Hope
Innovations in Pancreatic Cancer: A Reason to HopeChristopher Kanski
 
Staging and surgery of gastric carcinoma
Staging and surgery of gastric carcinomaStaging and surgery of gastric carcinoma
Staging and surgery of gastric carcinomaHappykumar Kagathara
 
Management of colorectal cancer
Management of colorectal cancer Management of colorectal cancer
Management of colorectal cancer Mohamed Abdulla
 
Initial chemotherapy and radiation for pancreatic cancer
Initial chemotherapy and radiation for pancreatic cancerInitial chemotherapy and radiation for pancreatic cancer
Initial chemotherapy and radiation for pancreatic cancerDr Tauqeer A Siddiqui MD FACP
 
Gastric Cancer Evidence Based Management
Gastric Cancer Evidence Based ManagementGastric Cancer Evidence Based Management
Gastric Cancer Evidence Based ManagementSheetal R Kashid
 
Gastric cancer: From Molecular Classification to Clinical Impact
Gastric cancer: From Molecular Classification to Clinical ImpactGastric cancer: From Molecular Classification to Clinical Impact
Gastric cancer: From Molecular Classification to Clinical ImpactMohamed Abdulla
 
Pancreatic neuroendocrine tumours
Pancreatic neuroendocrine tumoursPancreatic neuroendocrine tumours
Pancreatic neuroendocrine tumoursAtit Ghoda
 
Current Concept of Management Gastric Carcinoma
Current Concept of Management Gastric CarcinomaCurrent Concept of Management Gastric Carcinoma
Current Concept of Management Gastric Carcinomadrmangual1954
 
Liver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MD
Liver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MDLiver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MD
Liver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MDrick435
 
Management of patients with primary colorectal cancer and
Management of patients with primary colorectal cancer andManagement of patients with primary colorectal cancer and
Management of patients with primary colorectal cancer andYuvaraj Karthick
 
Laparoscopy for gastric cancer
Laparoscopy for gastric cancerLaparoscopy for gastric cancer
Laparoscopy for gastric cancerforegutsurgeon
 
Understanding the landscape of progress in the treatment of hepatocellular ca...
Understanding the landscape of progress in the treatment of hepatocellular ca...Understanding the landscape of progress in the treatment of hepatocellular ca...
Understanding the landscape of progress in the treatment of hepatocellular ca...Prof. Eric Raymond Oncologie Medicale
 
Carcinoid and pancreatic neuro endocrine tumor
Carcinoid and pancreatic neuro endocrine tumorCarcinoid and pancreatic neuro endocrine tumor
Carcinoid and pancreatic neuro endocrine tumorAlok Gupta
 

Tendances (19)

Gastric cancer seminar
Gastric cancer seminarGastric cancer seminar
Gastric cancer seminar
 
Pancreatic ca adjuvant badheeb
Pancreatic ca  adjuvant badheebPancreatic ca  adjuvant badheeb
Pancreatic ca adjuvant badheeb
 
Radiation for Gastric Cancer
Radiation for Gastric CancerRadiation for Gastric Cancer
Radiation for Gastric Cancer
 
MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)
MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)
MCO 2011 - Slide 22 - P. Rougier - Gastric and pancreatic cancers (part I)
 
Innovations in Pancreatic Cancer: A Reason to Hope
Innovations in Pancreatic Cancer: A Reason to HopeInnovations in Pancreatic Cancer: A Reason to Hope
Innovations in Pancreatic Cancer: A Reason to Hope
 
Staging and surgery of gastric carcinoma
Staging and surgery of gastric carcinomaStaging and surgery of gastric carcinoma
Staging and surgery of gastric carcinoma
 
Management of colorectal cancer
Management of colorectal cancer Management of colorectal cancer
Management of colorectal cancer
 
Initial chemotherapy and radiation for pancreatic cancer
Initial chemotherapy and radiation for pancreatic cancerInitial chemotherapy and radiation for pancreatic cancer
Initial chemotherapy and radiation for pancreatic cancer
 
Pancreatic
PancreaticPancreatic
Pancreatic
 
Gastric Cancer Evidence Based Management
Gastric Cancer Evidence Based ManagementGastric Cancer Evidence Based Management
Gastric Cancer Evidence Based Management
 
Gastric cancer: From Molecular Classification to Clinical Impact
Gastric cancer: From Molecular Classification to Clinical ImpactGastric cancer: From Molecular Classification to Clinical Impact
Gastric cancer: From Molecular Classification to Clinical Impact
 
Pancreatic neuroendocrine tumours
Pancreatic neuroendocrine tumoursPancreatic neuroendocrine tumours
Pancreatic neuroendocrine tumours
 
Current Concept of Management Gastric Carcinoma
Current Concept of Management Gastric CarcinomaCurrent Concept of Management Gastric Carcinoma
Current Concept of Management Gastric Carcinoma
 
Liver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MD
Liver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MDLiver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MD
Liver Transplantation for Hilar Cholangiocarcinoma - Robin D. Kim, MD
 
Management of patients with primary colorectal cancer and
Management of patients with primary colorectal cancer andManagement of patients with primary colorectal cancer and
Management of patients with primary colorectal cancer and
 
Carcinoma Pancreas Dr PS Lubana
Carcinoma  Pancreas Dr PS LubanaCarcinoma  Pancreas Dr PS Lubana
Carcinoma Pancreas Dr PS Lubana
 
Laparoscopy for gastric cancer
Laparoscopy for gastric cancerLaparoscopy for gastric cancer
Laparoscopy for gastric cancer
 
Understanding the landscape of progress in the treatment of hepatocellular ca...
Understanding the landscape of progress in the treatment of hepatocellular ca...Understanding the landscape of progress in the treatment of hepatocellular ca...
Understanding the landscape of progress in the treatment of hepatocellular ca...
 
Carcinoid and pancreatic neuro endocrine tumor
Carcinoid and pancreatic neuro endocrine tumorCarcinoid and pancreatic neuro endocrine tumor
Carcinoid and pancreatic neuro endocrine tumor
 

Similaire à Hepatoid adenocarcinoma of the stomach

Hepatocellular & Pancreatic Carcinomas
Hepatocellular & Pancreatic CarcinomasHepatocellular & Pancreatic Carcinomas
Hepatocellular & Pancreatic CarcinomasRHMBONCO
 
Case Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young Lady
Case Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young LadyCase Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young Lady
Case Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young Ladyzunaira75
 
Pancreatic Carcinoma Research Paper
Pancreatic Carcinoma Research PaperPancreatic Carcinoma Research Paper
Pancreatic Carcinoma Research PaperChristine White
 
The Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast CancerThe Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast CancerJohnJulie1
 
The Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast CancerThe Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast Cancersuppubs1pubs1
 
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportSolid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportJohnJulie1
 
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportSolid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportJapaneseJournalofGas
 
Egypt met hepato
Egypt met hepatoEgypt met hepato
Egypt met hepatoDRTINY
 
Atypical Metastatic Presentations in Colorectal Cancer A Case Series.pdf
Atypical Metastatic Presentations in Colorectal Cancer  A Case Series.pdfAtypical Metastatic Presentations in Colorectal Cancer  A Case Series.pdf
Atypical Metastatic Presentations in Colorectal Cancer A Case Series.pdfSarah Adams
 
gastriccancer.ppt
gastriccancer.pptgastriccancer.ppt
gastriccancer.pptKhalidfadol
 
gastriccancer.ppt
gastriccancer.pptgastriccancer.ppt
gastriccancer.pptKhalidfadol
 
gastriccancer.ppt
gastriccancer.pptgastriccancer.ppt
gastriccancer.pptTyronBn
 
gastriccancer types classified and manage
gastriccancer types classified and managegastriccancer types classified and manage
gastriccancer types classified and manageShehinSalim3
 
Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...
Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...
Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...komalicarol
 
Malignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptxMalignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptxPushpa Lal Bhadel
 
Benign tumors of the liver: Tumor like lesions
Benign tumors of the liver: Tumor like lesionsBenign tumors of the liver: Tumor like lesions
Benign tumors of the liver: Tumor like lesionsPratap Tiwari
 
Pancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case Report
Pancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case ReportPancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case Report
Pancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case Reportclinicsoncology
 

Similaire à Hepatoid adenocarcinoma of the stomach (20)

Oesophageal cancer osama
Oesophageal cancer osamaOesophageal cancer osama
Oesophageal cancer osama
 
Hepatocellular & Pancreatic Carcinomas
Hepatocellular & Pancreatic CarcinomasHepatocellular & Pancreatic Carcinomas
Hepatocellular & Pancreatic Carcinomas
 
Case Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young Lady
Case Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young LadyCase Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young Lady
Case Report: Mucinous Cyst Adenocarcinoma of Ovary in a Young Lady
 
Austin Journal of Clinical Case Reports
Austin Journal of Clinical Case ReportsAustin Journal of Clinical Case Reports
Austin Journal of Clinical Case Reports
 
Pancreatic Carcinoma Research Paper
Pancreatic Carcinoma Research PaperPancreatic Carcinoma Research Paper
Pancreatic Carcinoma Research Paper
 
The Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast CancerThe Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast Cancer
 
The Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast CancerThe Stomach: An Uncommon Site for Metastatic Breast Cancer
The Stomach: An Uncommon Site for Metastatic Breast Cancer
 
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportSolid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
 
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportSolid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
 
Egypt met hepato
Egypt met hepatoEgypt met hepato
Egypt met hepato
 
Carcinoma Pancreas.pptx
Carcinoma Pancreas.pptxCarcinoma Pancreas.pptx
Carcinoma Pancreas.pptx
 
Atypical Metastatic Presentations in Colorectal Cancer A Case Series.pdf
Atypical Metastatic Presentations in Colorectal Cancer  A Case Series.pdfAtypical Metastatic Presentations in Colorectal Cancer  A Case Series.pdf
Atypical Metastatic Presentations in Colorectal Cancer A Case Series.pdf
 
gastriccancer.ppt
gastriccancer.pptgastriccancer.ppt
gastriccancer.ppt
 
gastriccancer.ppt
gastriccancer.pptgastriccancer.ppt
gastriccancer.ppt
 
gastriccancer.ppt
gastriccancer.pptgastriccancer.ppt
gastriccancer.ppt
 
gastriccancer types classified and manage
gastriccancer types classified and managegastriccancer types classified and manage
gastriccancer types classified and manage
 
Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...
Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...
Yolk Sac Tumor as a Rare Cause of Esophageal Stricture in a 5-Year-Old Girl: ...
 
Malignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptxMalignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptx
 
Benign tumors of the liver: Tumor like lesions
Benign tumors of the liver: Tumor like lesionsBenign tumors of the liver: Tumor like lesions
Benign tumors of the liver: Tumor like lesions
 
Pancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case Report
Pancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case ReportPancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case Report
Pancreatic Metastasis from Unresectable Lung Adenocarcinoma: A Case Report
 

Plus de Alexander Decker

Abnormalities of hormones and inflammatory cytokines in women affected with p...
Abnormalities of hormones and inflammatory cytokines in women affected with p...Abnormalities of hormones and inflammatory cytokines in women affected with p...
Abnormalities of hormones and inflammatory cytokines in women affected with p...Alexander Decker
 
A validation of the adverse childhood experiences scale in
A validation of the adverse childhood experiences scale inA validation of the adverse childhood experiences scale in
A validation of the adverse childhood experiences scale inAlexander Decker
 
A usability evaluation framework for b2 c e commerce websites
A usability evaluation framework for b2 c e commerce websitesA usability evaluation framework for b2 c e commerce websites
A usability evaluation framework for b2 c e commerce websitesAlexander Decker
 
A universal model for managing the marketing executives in nigerian banks
A universal model for managing the marketing executives in nigerian banksA universal model for managing the marketing executives in nigerian banks
A universal model for managing the marketing executives in nigerian banksAlexander Decker
 
A unique common fixed point theorems in generalized d
A unique common fixed point theorems in generalized dA unique common fixed point theorems in generalized d
A unique common fixed point theorems in generalized dAlexander Decker
 
A trends of salmonella and antibiotic resistance
A trends of salmonella and antibiotic resistanceA trends of salmonella and antibiotic resistance
A trends of salmonella and antibiotic resistanceAlexander Decker
 
A transformational generative approach towards understanding al-istifham
A transformational  generative approach towards understanding al-istifhamA transformational  generative approach towards understanding al-istifham
A transformational generative approach towards understanding al-istifhamAlexander Decker
 
A time series analysis of the determinants of savings in namibia
A time series analysis of the determinants of savings in namibiaA time series analysis of the determinants of savings in namibia
A time series analysis of the determinants of savings in namibiaAlexander Decker
 
A therapy for physical and mental fitness of school children
A therapy for physical and mental fitness of school childrenA therapy for physical and mental fitness of school children
A therapy for physical and mental fitness of school childrenAlexander Decker
 
A theory of efficiency for managing the marketing executives in nigerian banks
A theory of efficiency for managing the marketing executives in nigerian banksA theory of efficiency for managing the marketing executives in nigerian banks
A theory of efficiency for managing the marketing executives in nigerian banksAlexander Decker
 
A systematic evaluation of link budget for
A systematic evaluation of link budget forA systematic evaluation of link budget for
A systematic evaluation of link budget forAlexander Decker
 
A synthetic review of contraceptive supplies in punjab
A synthetic review of contraceptive supplies in punjabA synthetic review of contraceptive supplies in punjab
A synthetic review of contraceptive supplies in punjabAlexander Decker
 
A synthesis of taylor’s and fayol’s management approaches for managing market...
A synthesis of taylor’s and fayol’s management approaches for managing market...A synthesis of taylor’s and fayol’s management approaches for managing market...
A synthesis of taylor’s and fayol’s management approaches for managing market...Alexander Decker
 
A survey paper on sequence pattern mining with incremental
A survey paper on sequence pattern mining with incrementalA survey paper on sequence pattern mining with incremental
A survey paper on sequence pattern mining with incrementalAlexander Decker
 
A survey on live virtual machine migrations and its techniques
A survey on live virtual machine migrations and its techniquesA survey on live virtual machine migrations and its techniques
A survey on live virtual machine migrations and its techniquesAlexander Decker
 
A survey on data mining and analysis in hadoop and mongo db
A survey on data mining and analysis in hadoop and mongo dbA survey on data mining and analysis in hadoop and mongo db
A survey on data mining and analysis in hadoop and mongo dbAlexander Decker
 
A survey on challenges to the media cloud
A survey on challenges to the media cloudA survey on challenges to the media cloud
A survey on challenges to the media cloudAlexander Decker
 
A survey of provenance leveraged
A survey of provenance leveragedA survey of provenance leveraged
A survey of provenance leveragedAlexander Decker
 
A survey of private equity investments in kenya
A survey of private equity investments in kenyaA survey of private equity investments in kenya
A survey of private equity investments in kenyaAlexander Decker
 
A study to measures the financial health of
A study to measures the financial health ofA study to measures the financial health of
A study to measures the financial health ofAlexander Decker
 

Plus de Alexander Decker (20)

Abnormalities of hormones and inflammatory cytokines in women affected with p...
Abnormalities of hormones and inflammatory cytokines in women affected with p...Abnormalities of hormones and inflammatory cytokines in women affected with p...
Abnormalities of hormones and inflammatory cytokines in women affected with p...
 
A validation of the adverse childhood experiences scale in
A validation of the adverse childhood experiences scale inA validation of the adverse childhood experiences scale in
A validation of the adverse childhood experiences scale in
 
A usability evaluation framework for b2 c e commerce websites
A usability evaluation framework for b2 c e commerce websitesA usability evaluation framework for b2 c e commerce websites
A usability evaluation framework for b2 c e commerce websites
 
A universal model for managing the marketing executives in nigerian banks
A universal model for managing the marketing executives in nigerian banksA universal model for managing the marketing executives in nigerian banks
A universal model for managing the marketing executives in nigerian banks
 
A unique common fixed point theorems in generalized d
A unique common fixed point theorems in generalized dA unique common fixed point theorems in generalized d
A unique common fixed point theorems in generalized d
 
A trends of salmonella and antibiotic resistance
A trends of salmonella and antibiotic resistanceA trends of salmonella and antibiotic resistance
A trends of salmonella and antibiotic resistance
 
A transformational generative approach towards understanding al-istifham
A transformational  generative approach towards understanding al-istifhamA transformational  generative approach towards understanding al-istifham
A transformational generative approach towards understanding al-istifham
 
A time series analysis of the determinants of savings in namibia
A time series analysis of the determinants of savings in namibiaA time series analysis of the determinants of savings in namibia
A time series analysis of the determinants of savings in namibia
 
A therapy for physical and mental fitness of school children
A therapy for physical and mental fitness of school childrenA therapy for physical and mental fitness of school children
A therapy for physical and mental fitness of school children
 
A theory of efficiency for managing the marketing executives in nigerian banks
A theory of efficiency for managing the marketing executives in nigerian banksA theory of efficiency for managing the marketing executives in nigerian banks
A theory of efficiency for managing the marketing executives in nigerian banks
 
A systematic evaluation of link budget for
A systematic evaluation of link budget forA systematic evaluation of link budget for
A systematic evaluation of link budget for
 
A synthetic review of contraceptive supplies in punjab
A synthetic review of contraceptive supplies in punjabA synthetic review of contraceptive supplies in punjab
A synthetic review of contraceptive supplies in punjab
 
A synthesis of taylor’s and fayol’s management approaches for managing market...
A synthesis of taylor’s and fayol’s management approaches for managing market...A synthesis of taylor’s and fayol’s management approaches for managing market...
A synthesis of taylor’s and fayol’s management approaches for managing market...
 
A survey paper on sequence pattern mining with incremental
A survey paper on sequence pattern mining with incrementalA survey paper on sequence pattern mining with incremental
A survey paper on sequence pattern mining with incremental
 
A survey on live virtual machine migrations and its techniques
A survey on live virtual machine migrations and its techniquesA survey on live virtual machine migrations and its techniques
A survey on live virtual machine migrations and its techniques
 
A survey on data mining and analysis in hadoop and mongo db
A survey on data mining and analysis in hadoop and mongo dbA survey on data mining and analysis in hadoop and mongo db
A survey on data mining and analysis in hadoop and mongo db
 
A survey on challenges to the media cloud
A survey on challenges to the media cloudA survey on challenges to the media cloud
A survey on challenges to the media cloud
 
A survey of provenance leveraged
A survey of provenance leveragedA survey of provenance leveraged
A survey of provenance leveraged
 
A survey of private equity investments in kenya
A survey of private equity investments in kenyaA survey of private equity investments in kenya
A survey of private equity investments in kenya
 
A study to measures the financial health of
A study to measures the financial health ofA study to measures the financial health of
A study to measures the financial health of
 

Dernier

FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...bkling
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 

Dernier (20)

FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 

Hepatoid adenocarcinoma of the stomach

  • 1. Journal of Biology, Agriculture and Healthcare www.iiste.org ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol 1, No.4, 2011 Hepatoid Adenocarcinoma of the Stomach – a rare histology of Gastric Adenocarcinoma in an adolescent: a case report. Shyam Sharma1* Krishnangshu Bhanja Choudhury1 Ramesh Kothari1 Anup Majumdar1 1. Department of Radiotherapy, IPGME&R, Kolkata * Email of corresponding author: sharma.shyam123@gmail.com Abstract Hepatoid adenocarcinoma is a rare subtype of extra-hepatic adenocarcinoma generally characterized by hepatocellular carcinoma like foci in the background of adenocarcinoma. Stomach is the most frequent site where hepatoid adenocarcinoma occurs, although it has been described in many other organs. We describe a case of 16 years old adolescent girl who was diagnosed as a case of “hepatoid adenocarcinoma of stomach’, an unlikely presentation at this young age. Keywords: Hepatoid adenocarcinoma, stomach, adolescent. 1. Introduction: Gastric adenocarcinoma is a malignant epithelial tumor, originating from glandular epithelium of the gastric mucosa. Hepatoid adenocarcinoma (HAC) is a type of extra-hepatic adenocarcinoma, which shows a striking morphologic similarity to hepatocellular carcinoma (Gao et al. 2007). It is generally characterized by adenocarcinomatous and hepatocellular carcinoma (HCC)-like foci. This variant of adenocarcinoma has been demonstrated to be an alpha-fetoprotein (AFP)-producing carcinoma arising in extra hepatic organs, and it mimics hepatocellular carcinoma in morphological and functional terms. Alpha- fetoprotein (AFP) is a fetal serum protein produced by fetal liver and yolk sac cells, and by some fetal gastrointestinal cells. After birth, the levels of the protein in serum rapidly decrease. 2. Case report: A 16 years old adolescent girl presented with aggravating abdominal pain for 2 months. She had history of repeated vomiting, aggravated by food intake for last three months, and anorexia, fatigue and unexplained weight loss of ten kilograms over the same duration. The initial ultrasonography was unremarkable with no focal defects seen in liver or abdominal lymphadenopathy. The upper gastrointestinal endoscopy revealed a circumferential mass lesion at the gastric antrum occluding the lumen. The biopsies from the antral growth showed histological features of fragmented bits of ulcero-necrotic slough, granulation tissue and acute inflammatory exudates invaded by several atypical cells with pleomorphic hyperchromatic nuclei, irregular nuclear membrane and prominent nucleoli; features highly suggestive of a poorly differentiated malignant lesion. Tumor marker (CEA and CA19-9) serum levels were normal. Based on this report the patient underwent a distal gastrectomy with dissection of sixteen lymph nodes and biopsy of omental tissue. The stomach showed a large tumour of nine centimeters in its greatest axis, with histology showing features of “polygonal cells arranged in solid nest, with scattered large multinucleated giant cells, and well differentiated papillary pattern with clear cytoplasm – suggestive of Hepatoid Adenocarcinoma”. [Figure 1] The carcinoma had infiltrated the muscle coat and had extended into the serosa. The surgical lines of resection were free of lesion. Four out of sixteen lymph nodes were positive for metastasis. The omental tissue did not show any metastasis. The tumour was immunopositive for cytokeratin and Alpha-fetoprotein (AFP) [Figure 2] and negative for C-kit, CD 34, Desmin, SMA and S-100 protein. The postoperative AFP was elevated measuring 5090ng/ml. A post-operative CT scan showed multiple liver metastases in both 27
  • 2. Journal of Biology, Agriculture and Healthcare www.iiste.org ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol 1, No.4, 2011 lobes with more on right lobe and portal lymphadenopathy. The patient underwent palliative chemotherapy of six cycles comprising of docetaxel, cisplatin and 5fluorouracil. 3. Discussion: Stomach cancer is the fourth most common cancer worldwide with 930,000 cases diagnosed in 2002 (Parkin et al. 2005). The studies show that less than 5% of stomach cancers occur in people less than 40 years of age with 81.1% of that 5% in the age-group of 30 to 39 and 18.9% in the age-group of 20 to 29 (Simsa et al. 2004). The overwhelming pathological variety of gastric carcinoma is adenocarcinoma found in 90% of cases. Ishikura et al. proposed the term “hepatoid adenocarcinoma of the stomach” for primary gastric carcinomas characterized histologically by hepatoid differentiation and the production of large amounts of AFP (Ishikura et al. 1985). This unique histological hepatoid adenocarcinoma has also been reported in the lung, pancreas, uterus and ovary (Okunaka et al. 1992; Yamada et al. 1994; Itoh et al. 1992; McIntire et al. 1975). The tumor is immunohistochemistry positive is for cytokeratin and Alpha fetoprotein and negative for C-kit, CD 34, Desmin, SMA and S-100 protein. There has been mention of case reports of "hepatoid adenocarcinoma of the stomach" in the literature. In the literature, 86 cases described by the term “hepatoid adenocarcinoma of the stomach” have been reported, including the present case. In 2001, Inawaga et al revised all these cases and published a report with the main clinical characteristics of this pathological variety (Inagawa et al. 2001). The average age of the patients was 63.5 years (range, 44–87 years), and the male-to-female ratio was 58:25 (the sex was not stated for 2 patients). In most of these patients, the tumors occurred mainly at the antrum (60.2%). The average serum AFP level was 51130.1 ng/ml (range, less than 1.0–700000ng/ml); that is, much higher than normal. Although there were no major symptoms sufficient to allow diagnosis of this type of cancer, epigastric pain and general fatigue because of anemia, were the most common symptoms. The average maximal tumor diameter was 6.5cm (range, 1.6–14.0cm). Most cases also had metastatic disease to the lymph nodes or liver. Furthermore, most of the patients died within 2 years of surgery, despite systemic chemotherapy having been administered in several patients. These reports suggest that even early stage hepatoid adenocarcinoma has an extremely poor prognosis, because of the frequent occurrence of liver and/or lymph node metastases (Nagai et al. 1993; Chang et al. 1991). However, the reasons for the poor prognosis are not clearly understood. Nagai et al. reported that hepatoid adenocarcinoma had a poor prognosis compared with that for AFP-producing non-hepatoid adenocarcinoma (Nagai et al. 1993). One possibility is that hepatoid adenocarcinoma produces AAT and/or ACT as well as AFP. AAT and ACT have immunosuppressive and protease-inhibiting properties that enhance invasiveness [Redelman & Hudig 1980; Pasternack & Eisen 1985). Also, AFP has a suppressive effect on lymphocyte transformation. In addition, Koide et al. have reported that AFP-producing gastric cancer has high proliferative activity, weak apoptosis, and rich neovascularization (Koide et al. 1999). Furthermore, as Chang et al. have reported, even if no metastasis is present preoperatively, liver metastasis can occur within a year after surgery, and, thus, close observation and long-term follow-up of patients are required (Chang et al. 1991). The management of this special subtype has still not clearly been demarcated with majority of patients detected in metastatic stage requiring palliative chemotherapy with docetaxel, doxorubicin, cisplatin, capecitabine, irinotecan and 5-fluorouracil in various combinations (Van Cutsem et al. 2006; Dank et al. 2008). The outcome of the subtype is poor for all stages of disease. In conclusion, we report a rare case of hepatoid adenocarcinoma of the stomach, diagnosed in an adolescent patient with well defined clinicopathological features. The only hope for curative treatment in this rare variety of tumour is early diagnosis and administration of novel chemotherapeutic drugs for better disease control. 28
  • 3. Journal of Biology, Agriculture and Healthcare www.iiste.org ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol 1, No.4, 2011 References Gao YB, Zhang DF, Jin XL, Xiao JC. (2007), “Preliminary study on the clinical and pathological relevance of gastric hepatoid adenocarcinoma”, Journal of Digestive Diseases 8, 23-28. Parkin DM, Bray F, Ferlay J, Pisani P. (2005), "Global cancer statistics, 2002". CA: a Cancer Journal for Clinicians 55(2), 74–108. Simsa J, Leffler J, Hoch J, Linke Z, Pádr R. (2004), "Gastric cancer in young patients--is there any hope for them?", Acta Chirurgica Belgica 104 (6): 673–6. Ishikura H, Fukasawa Y, Ogasawara K, Natori T, Tsukada Y, Aizawa M. (1985), “An AFP- producing gastric carcinoma with features of hepatic differentiation: a case report”, Cancer 56, 840–8. Okunaka T, Kato H, Konaka C, Yamamoto H, Furukawa K. (1992), “Primary lung cancer producing alpha- fetoprotein”, Ann Thorac Surg 53, 151-152. Itoh T, Kishi K, Tojo M, Kitamura M, Kinoshita Y, Inatome T. (1992), “Acinal cell carcinoma of the pancreas with elevated serum alphafetoprotein levels: a case report and a review of 28 cases reported in Japan”, Gastroenterology Japan 27, 785-791. Yamada K, Fujioka Y, Ebihara Y, Kiriyama I, Suzuki H, Akimoto M. (1994), “Alpha-fetoprotein-producing undifferenciated carcinoma of the bladder”, Journal of Uroology 152, 958-960. McIntire KR, Waldmann TA, Moertel CG, Go WLW. (1975),“Serum α-fetoprotein in patients with neoplasms of gastrointestinal tract”. Cancer Research 35, 991-996. Inagawa S, Shimazaki J, Hori M, Yoshimi F, Adachi S, Kawamoto T,Fukao K, Itabashi M. (2001), “Hepatoid adenocarcinoma of the stomach:case report”, Gastric Cancer 4(1), 43-52. Nagai E, Ueyama T, Yao T, Tsuneyoshi M. (1993), “Hepatoid adenocarcinoma of the stomach”, Cancer 72,1827–35. Chang YC, Nagasue N, Abe S, Kohno H, Kumar DD, Nakamura T. (1991), “á-Fetoprotein-producing early gastric cancer with liver metastasis: report of three cases”, Gut 32, 542–5. Redelman D, Hudig D. (1980), “The mechanism ot cell-mediated cytotoxicity. I. Killing by murine cytotoxic T lymphocytes requires cell surface thiols and activate proteases”, Journal of Immunolology 124, 870–8. Pasternack MS, Eisen HN. (1985), “A novel serum esterase expressed by cytotoxic T lymphocytes”, Nature 314, 743–5. Koide N, Nishio A, Igarashi J, Kajikawa S, Adachi W, Amano J. (1999), “á-Fetoprotein-producing gastric cancer: histochemical analysis of cell proliferation, apoptosis, and angiogenesis”, American Journal of Gastroenterology 94, 1658–63. Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M, Chao Y, Voznyl E, Risse ML, Ajani JA. (2006), “V325 Study Group: Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: A report of the V-325 Study Group”, Journal of Clinical Oncology 24, 4991-7. Dank M, Zaluski J, Barone C, Valvere V, Yalcin S, Peschel C, Wenzcl M, Goker E, Cisar L, Wang K, Bugat R. (2008), “Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or the esophagogastric junction”, Annals of Oncology 19, 1450-7. 29
  • 4. Journal of Biology, Agriculture and Healthcare www.iiste.org ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol 1, No.4, 2011 Figures: Figure 1. Gastric biopsy of the distal gastrectomy specimen 400x hematoxylin eosin staining Figure 2. The gastric biopsy was strongly immnuopositive for AFP 30