Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings

AIM: To evaluate the dynamic computed tomography(CT) findings of liver metastasis from hepatoid adenocarcinoma of the stomach(HAS) and compared them with hepatocellular carcinoma(HCC).METHODS: Between January 2000 and January 2015, 8 patients with pathologically proven HAS and liver metastases were enrolled. Basic tumor status was evaluated for the primary tumor location and metastatic sites. The CT findings of the liver metastases were analyzed for tumor number and size, presence of tumor necrosis, hemorrhage, venous tumor thrombosis, and dynamic enhancing pattern.RESULTS: The body and antrum were the most common site for primary HAS(n = 7), and observed metastatic sites included the liver(n = 8), lymph nodes(n = 7), peritoneum(n = 4), and lung(n = 2). Most of the liver metastases exhibited tumor necrosis regardless of tumor size. By contrast, tumor hemorrhage was observed only in liver lesions larger than 5 cm(n = 4). Three patterns of venous tumor thrombosis were identified: direct venous invasion by the primary HAS(n = 1), direct venous invasion by the liver metastases(n = 7), and isolated portal vein tumor thrombosis(n = 2). Dynamic CT revealed arterial hyperattenuation and late phase washout in all the liver metastases.CONCLUSION: On dynamic CT, liver metastasis from HAS shared many imaging similarities with HCC. For liver nodules, the presence of isolated portal vein tumor thrombosis and a tendency for tumor necrosis are imaging clues that suggest the diagnosis of HAS.

Cerebral metastasis from hepatoid adenocarcinoma of the stomach

We first report a rare case of metastasis from gastric hepatoid adenocarcinoma (HAC) to cerebral parenchyma, in a 50-year-old Chinese patient. He complained of a one-month history of a paroxysm of headache in the left temple and pars parietalis accompanied with binocular caligation caligo, insensible feeling of limbs and transient anepia. Magnetic resonance (MR) imaging revealed a spherical occupying lesion in the left posterior-temple lobe which was clinically diagnosed as a metastatic tumor. Three years ago, the patient accepted total gastrectomy as he was pathologically diagnosed at gastroscopy having an adenocarcinoma. Eight months after gastrectomy, the occupying lesion in liver was detected by ultrasound and CT, and he accepted transcatheter arterial embolization. Before operation of the brain metastasis, no obvious abnormality was found in liver by ultrasound. Histopathological characteristics of the brain tumor were identical to those of stomach tumor. The growth pattern of both tumors showed solid cell nests. The tumor cells were polygonal, and had abundant eosinophilic cytoplasm and round nuclei with obvious nucleoli. Sinusoid-like blood spaces were located between nodular tumor cells. Immunohistochemistry-stained tumor cells were positive for AFP and negative for Hep-Par-1. According to these histopathological findings, both tumors were diagnosed as HAC and metastatic HAC. The patient remained alive 16 mo after tumorectomy of the cerebral metastasis. The differential diagnosis of brain metastasis from metastatic tumors should use a panel of antibodies to avoid confusing with the brain metastasis of hepatocellular carcinoma (HCC). This paper describes this rare case of metastasis from gastric hepatoid adenocarcinoma to cerebral parenchyma, and provides a review of the literature concerning its histopathological and immunohistochemical characteristics.

老年胃肝样腺癌患者临床及病理特征分析

目的探讨老年胃肝样腺癌（HAS）的诊断、临床、病理特征及治疗。方法回顾性分析2013年5月-2015年7月期间12例老年胃肝样腺癌患者（胃肝样腺癌组）及100例老年胃腺癌患者（胃腺癌组）的诊治情况。结果老年HAS男性多于女性，平均患病年龄（68．5±5．6）岁，与胃腺癌组患者相似（P〉O．05），但老年HAS组患者m期占41．7％，IV期占33．3％，比胃腺癌组患者TNM分期更晚（P〈0．05），老年HAS组有83．3％（10／12）的患者血清AFP升高，而胃腺癌组患者术前均未发现AFP升高（P〈0．05），术后免疫组化老年HAS组有75％（9／12）的患者AFP高表达，胃腺癌组患者同样均无AFP高表达（P〈0.05），老年HAS组与胃腺癌组DFS分别为（33．3％，69％，P=0．014）。结论HAS是一种特殊类型的胃癌，具有独特的病理及生物学形态，较普通胃腺癌，有更高的恶性程度，且不具有典型的临床表现，难以早发现早诊断，预后极差，血清AFP升高可能是HAS唯一重要的临床病理特点。

食管胃结合部肝样腺癌的诊断与治疗

1临床资料 患者男，34岁。因进行性吞咽困难2个月，于2014年12月31日收入首都医科大学附属北京朝阳医院胸外科。患者进食粗硬食物有哽噎感，无腹痛、黑便；近2个月体质量减轻约10kg，既往体健，否认高血压病、糖尿病等慢性病史。体格检查：身高182cm，体质量77kg，发育正常，营养中等，全身浅表淋巴结未触及肿大，心肺腹无异常。