[An autopsy case of a gastric cancer associated with elevated AFP, CEA and CA19-9]

A 48-year-old male developed gastric cancer (Borrmann III) with lung and liver metastases. Laboratory examination revealed a markedly elevated AFP (24, 241 ng/ml), CEA (9739.8 ng/ml), and CA-19-9 (726U/ml). Nevertheless, he underwent a subtotal gastrectomy for the hemostasis of a bleeding malignant lesion. Histological examination showed a moderately differentiated adenocarcinoma. A PAP for an AFP and a CEA disclosed positive staining. In addition, An autopsy revealed metastases to the liver and lungs with a positive result of PAP for AFP and CEA. Further, CA19-9 also was confirmed weakly in these same tissues, histochemically. Therefore this gastric cancer was considered an AFP, CEA, and CA19-9-producing tumor. Gastric cancer with 3 elevated tumor markers in the same patient is rare and its mechanism may elucidate the origin of gastric cancer and the resulting differentiation in the foregut.