Hepatoid adenocarcinoma of the stomach is a special and easily misdiagnosed or missed diagnosed subtype of gastric cancer with poor prognosis but curative for patients of pN0/1: the experience of a single center

Yibin Xie; Zhonghai Zhao; Peng Li; Yang Wang; Chunguang Guo; Xiaoliang Wang; Wei Tang; Qian Liu; Ning Lu; Liyan Xue; Dongbing Zhao

Hepatoid adenocarcinoma of the stomach is a special and easily misdiagnosed or missed diagnosed subtype of gastric cancer with poor prognosis but curative for patients of pN0/1: the experience of a single center

Int J Clin Exp Med. 2015 May 15;8(5):6762-72. eCollection 2015.

Authors

Yibin Xie¹, Zhonghai Zhao², Peng Li¹, Yang Wang¹, Chunguang Guo¹, Xiaoliang Wang³, Wei Tang⁴, Qian Liu¹, Ning Lu³, Liyan Xue³, Dongbing Zhao¹

Affiliations

¹ Department of Abdominal Surgical Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021, China.
² Department of General Surgery, Beijing Puren Hospital Beijing 100062, China.
³ Department of Pathology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021, China.
⁴ Department of Diagnostic Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021, China.

PMID: 26221214
PMCID: PMC4509159

Abstract

Aim: To document the clinicopathological characteristics and analyze the possible reasons for misdiagnosis or missed diagnosis of hepatoid adenocarcinoma of the stomach (HAS), using data from a single center.

Methods: We retrospectively analyzed 19 patients initially diagnosed as HAS and 7 patients initially diagnosed as common gastric cancer with high levels of serum α-fetoprotein (AFP). All had undergone surgical treatment, except 3 patients only had biopsies at our hospital. Immunohistochemistry for AFP and Hepatocyte antigen was performed. Final diagnosis for these 26 patients were made after HE and immunohistochemistry slides reviewed by 2 experienced pathologists. Prognostic factors were determined by univariate analysis.

Results: Nineteen cases were confirmed to be HAS. A total of 4 out of 19 cases initially diagnosed as HAS and 4 out of 7 cases initially diagnosed as common gastric adenocarcinoma were misdiagnosed/missed diagnosed, thus, the misdiagnosis/missed diagnosis rate was 30.8% (8/26). The incidence of HAS among gastric cancer in our center was 0.19% (19/9915). Sixteen (84.2%) patients showed T stages greater than T2, 12 (70.6%) patients had positive lymph nodes in 17 available patients and 3 (15.8%) of the patients with tumors presented liver metastasis at the time of diagnosis. Histologically, cytoplasmic staining types included 10 cases of eosinophilic, 1 case of clear, 5 cases of clear mixed with eosinophilic and 3 cases of basophilic. Fourteen (73.7%) patients expressed AFP, whereas only 6 (31.6%) were hepatocyte-positive. Univariate analysis showed that N stage (HR 2.429, P=0.007) and tumor AFP expression (HR 0.428, P=0.036) were significantly associated with disease-free survival. The median overall survival time was 12.0 months, and the median disease-free survival time was 7.0 months. Four (80%) of 5 N0 patients and 2 (50%) of 4 N1 patients survived without progression, but no N2-3 patients survived.

Conclusion: HAS remains easily being misdiagnosed/missed diagnosed based on a pathological examination, probably because the condition is rare and has various cytoplasmic types. Although the survival rate for HAS is poor, a curative effect may be achieved for N0 or N1 cases.

Keywords: Stomach; diagnosis; hepatoid adenocarcinoma; survival; α-fetoprotein (AFP).