Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 15, Number 10, October 2024, pages 304-309

Alpha-Fetoprotein-Producing Hepatoid Adenocarcinoma of the Stomach

Figures

Figure 1.
Figure 1. Contrast-enhanced CT scan of the abdomen/pelvis showing abnormal gastric wall thickening with extensive liver metastases. (a) An axial view of the CT scan with yellow lines estimating gastric wall thickness. (b) A coronal view with a yellow arrow showing stomach wall thickening consistent with gastric malignancy. CT: computed tomography.
Figure 2.
Figure 2. An endoscopy image showing a large, fungating, and ulcerated mass with friability involving almost the entire lesser curvature of the stomach (green arrows).
Figure 3.
Figure 3. (a) Histological specimen showing mainly sheets of malignant cells (basophilic cells shown by green arrow) with focal glandular formation and prominent desmoplastic stromal response. The non-involved gastric glands (acidophilic staining and shown by black arrow) show focal intestinal metaplasia that is highlighted by PAS staining. (b) A closer look at the tumor showing sheets of malignant cells, pseudoglandular and hepatoid components (green arrow). Immunohistochemical staining was strongly positive for AFP (c) and positive for CDX2 (d). AFP: alpha-fetoprotein; CDX2: caudal-type homeobox 2.
Figure 4.
Figure 4. (a, b) The biopsy specimen shows liver parenchyma (green arrows) infiltrated by tumor cells (red arrows) forming nests and rare glands in the background of necrosis. (c) Tumor cells (blue arrow) in the background of normal liver tissue (black arrow). (d) Immunohistochemical staining showed positivity for SALL4 (d), CDX2, and AFP. AFP: alpha-fetoprotein; CDX2: caudal-type homeobox 2; SALL4: Sal-like protein 4.

Table

Table 1. Patient’s Admission Laboratory Values Compared to Normal Ranges
 
VariablesAdmission labsNormal ranges
AFP: alpha-fetoprotein; CA: cancer antigen; CEA: carcinoembryonic antigen; LDH: lactate dehydrogenase.
Hemoglobin (Hb)6.812.0 - 16.0 g/dL
Alkaline phosphatase11134 - 104 U/L
Platelet count551140 - 440 × 103/mm3
Albumin3.23.5 - 5.7 g/dL
Blood glucose18070 - 100 g/dL
AFP1,2520.5 - 9 ng/mL
CA 12582.00 - 38 U/mL
CA 19-9680 - 35 U/mL
CEA1260 - 3 ng/mL
LDH144140 - 271 U/L
Helicobacter pylori stool antigenNegativeN/A