Clinicopathologial features of gastric hepatoid adenocarcinoma

Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by hepatocellular carcinoma-like histology. As details of this disease remain unknown, the aim of this study was to evaluate the clinicopathological features of GHA.

From January 2001 to December 2010, 4563 patients were diagnosed with primary gastric cancer at Chang Gung Memorial Hospital, Linkou Medical Center. Ten (0.22%) of these patients were diagnosed with GHA. The clinicopathological characteristics of these patients were collected retrospectively.

The median age at diagnosis was 65.5 years, and six patients (60%) were male. Seven patients had lymph node metastasis and five had distant metastasis, with the liver as the most common site (four cases). Serum alpha-fetoprotein (AFP) levels were elevated in seven of eight patients (median: 359.2 ng/ml; range: 4.3-6535.6 ng/ml). Endoscopically, six tumors were classified as Borrmann's type III cancer with the appearance of fungating mass lesion with a purple, berry-like surface. Of the five patients without distant metastasis, all received curative-intent surgery and four received adjuvant chemotherapy. Four patients with distant metastasis received either palliative operation or chemotherapy, and one patient received neither operation nor chemotherapy due to a poor performance status. The median survival time was 7.2 months (range: 0.7-131.8 months), and the 5-year survival rate was 20%. There was survival benefit in the chemotherapy groups.

GHA is a rare subtype of gastric cancer which is prone to lymph node and liver metastasis. Most GHAs appear as Borrmann's type III fungating mass lesion with a purple, berry-like surface. Although the prognosis of advanced stage GHA is poor, chemotherapy might provide some benefit.