Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2013 Jun;19(2):173-8. doi: 10.3350/cmh.2013.19.2.173. Epub 2013 Jun 27.
Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-year-old man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alpha-fetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymph-node metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP.
肝样腺癌（HAC）是一种罕见的肝外癌，其形态与肝细胞癌（HCC）相似。同一患者中同时发生 HCC 和 HAC 极为罕见。本文报道了 1 例 68 岁男性慢性乙型肝炎感染患者同时患有 HCC 和胃 HAC。该患者 9 年前曾被诊断为 HCC，并接受了右半肝切除术。术后 6 个月时，尾状叶 HCC 复发，经肝动脉化疗栓塞术成功治疗。此后，该患者定期随访，9 年内无肿瘤复发迹象。2010 年 7 月，其血清甲胎蛋白（AFP）水平从 6.5ng/mL 升高至 625.4ng/mL，且在肝动脉周围出现疑似单个转移性淋巴结，而无肝内病变。随后的上消化道内镜检查显示胃窦部有 4cm 大小的溃疡性病变。行胃次全切除术并清扫淋巴结。组织学检查显示一种特殊类型的肝外 AFP 产生性腺癌——HAC 伴淋巴结转移，提示即使在 HCC 患者中，HAC 也可能导致 AFP 异常升高。如果稳定的 HCC 患者 AFP 出现异常升高，应考虑 HAC。
