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A 60-year-old man developed upper-abdominal pain, bloating and black stools over about 15 days. Gastroscopy found a 3.5 cm ulcerated mass in the gastric antrum, and biopsy showed poorly differentiated adenocarcinoma. His blood AFP level was markedly elevated, while CT showed no obvious liver tumor.
He underwent radical gastrectomy. Pathology identified a rare hepatoid gastric adenocarcinoma with neuroendocrine differentiation. The tumor invaded the muscular layer and showed vascular invasion. One of 20 regional lymph nodes was positive. Immunohistochemistry supported the unusual tumor pattern, with AFP, synaptophysin and chromogranin A positivity.
His AFP level fell substantially within 10 days after surgery. Postoperative chemotherapy was offered, but he declined it and left the hospital.
He returned 6 months later. AFP had risen to above 2,000 ng/mL, although CT did not show an obvious new abnormality. He declined PET/CT and again left the hospital. Because the rising AFP was concerning but no recurrence or metastasis was confirmed, his latest cancer status remained uncertain at that follow-up.
This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full
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