Pure multiple hepatoid adenocarcinoma of the stomach: a rare case report

Heptoid adenocarcinoma (HAC) is a rare but important type of extrahepatic adenocarcinoma with highly aggressive behavior and a poor prognosis. The stomach is one of the organs in which HAC has been most commonly identified; however, multiple HACs in the stomach have not been previously reported. Here, we report the first case of multiple HACs in the stomach. A 46-year-old male with abdominal pain was found to have seven small to large ulcers scattered in the antrum and anterior wall of stomach. A gastric biopsy indicated poorly differentiated adenocarcinoma. The patient underwent 2 cycles of chemotherapy with oxaliplatin (130 mg; day 1) and capecitabine (2 mg, twice daily; days 1-14). One week after chemotherapy, alpha fetoprotein (AFP) serum levels were found to be markedly elevated (417.52 ng/ml). An expanded gastrectomy was then performed and seven 0.8-2.8 cm ulcerated tumors infiltrating into the gastric wall were found scattered on the antrum and anterior wall of the stomach. Histopathological analysis revealed that all of the tumors were comprised of cells with hepatoid-like features. Furthermore, the tumor cells demonstrated immunostaining positive for AFP, and Hepatocyte paraffin 1 (Hep Par 1). The diagnosis of pure multiple HACs producing AFP in the stomach was established. After the operation, the serum AFP level was significantly decreased (12.87 ng/ml). The patient received chemotherapy post-operatively, and has now survived 3 months without progression.