Clinical and Pathologic Analysis and Cause Analysis of Misdiagnosis of Six Patients with Hepatoid Adenocarcinoma of the Stomach

PENG Qiu-ping; KE Chuan-qing; PENG En-lan; FENG Qing-qing

doi:10.3969/j.issn.1002-3429.2015.01.015

Abstract：Objective To explore clinical characteristics, diagnosis and treatment of hepatoid adenocarcinoma of the stomach ( HAS) . Methods Six patients with HAS admitted to our hospital during January 2000 and January 2012 were col-lected, and their clinical data were analyzed retrospectively. Meanwhile, the related literatures were reviewed. Results There were 4 male and 2 female patients with an median age of 59 years. The initial clinical symptoms of HAS were upper ab-dominal pain and distension (4 cases), haematemesis and melena (1 case respectively). Before operation the serum level of alpha fetoprotein ( AFP) was detected in 3 patients, and the serum AFP level was elevated in 2 patients. Before operation there was 1 patient confirmed as having HAS, and 5 patients were diagnosed as having ordinary gastric cancer. After operation the pathologic types were poorly or moderately poorly differentiated adenocarcinoma accompanied by hepatoid adenocarcinoma in 6 patients. Immunohistochemistry:the tumor cells of adenocarcinoma differentiation zone were positive for carcinoembryonic antigen ( CEA) in 5 patients, and were negative for AFP in all patients. The tumor cells of hepatocellular carcinoma like dif-ferentiation zone were positive for AFP in 5 patients, and were positive for CEA in 1 patient. Surgery based combined therapy was applied in 6 patients, but the median survival time was 14 months. Conclusion HAS has certain clinical and pathologic characteristics with poor prognosis. Therefore, clinicians should raise awareness of this disease. Timely detection of tumor markers and biopsy pathological detection are essential to avoid misdiagnosis and missed diagnosis.