Department of Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Clin J Gastroenterol. 2024 Apr;17(2):234-239. doi: 10.1007/s12328-023-01910-x. Epub 2024 Jan 12.
Alpha-fetoprotein (AFP)-producing gastric cancer is a rare subtype of gastric cancer known for its aggressive nature. We present an uncommon case of a 60s male with multiple liver tumors, initially suggested as hepatocellular carcinoma (HCC) by imaging. However, a subsequent gastric biopsy revealed a poorly differentiated adenocarcinoma with hepatoid features, and liver biopsy mirrored these findings. The disease progressed swiftly, with the patient representing owing to the spontaneous rupture of a metastatic liver tumor, an extremely rare occurrence, especially in metastatic liver cancers. Such ruptures in AFP-producing gastric cancer may be attributed to the tumor's rich blood flow. Distinctly differentiating this subtype from HCC is pivotal for apt management, as was evident in our case. The diagnosis was particularly challenging due to the similarities in imaging presentations between AFP-producing gastric cancer liver metastasis and HCC. This case underscores the need for vigilant diagnosis, emphasizing the importance of liver biopsy, especially in the absence of chronic liver disease. It also highlights the potential complications, like spontaneous rupture, associated with this rare form of gastric cancer.
甲胎蛋白（AFP）产生的胃癌是一种罕见的胃癌亚型，以其侵袭性为特征。我们报告了一例 60 多岁男性的不常见病例，该患者最初因影像学表现提示为肝细胞癌（HCC）而存在多个肝肿瘤。然而，随后的胃活检显示出具有肝样特征的低分化腺癌，肝活检反映了这些发现。疾病迅速进展，由于转移性肝肿瘤的自发性破裂，患者出现失代偿，这种情况极为罕见，尤其是在转移性肝癌中。在 AFP 产生的胃癌中，这种破裂可能归因于肿瘤丰富的血流。从适当的管理角度来看，将这种亚型与 HCC 明显区分开来至关重要，在我们的病例中这一点很明显。由于 AFP 产生的胃癌肝转移和 HCC 的影像学表现相似，因此诊断特别具有挑战性。由于缺乏慢性肝病，特别是在这种情况下，强调了需要进行警惕性诊断，强调了肝活检的重要性。它还突出了这种罕见形式的胃癌相关的潜在并发症，如自发性破裂。
