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KMID : 0360319920240050674
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Journal of Korean Cancer Research Association
1992 Volume.24 No. 5 p.674 ~ p.683
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Clinico-pathologic Characteristics of Gastric Adenocarcinoma with Increased Serum Alpha-fetoperotein
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정태준
성건형/장정순/이종철/홍은경/이중달
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Abstract
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Gastric adenocarcinoma cells are known t produce fetal proteins into circulation and this fetal proteins detected in the blood have been a useful tool for diagnosis and follow-up of cancer patient. Since the alpha-fetoprotein(AFP) producing
gastric
adenocarcinoma was identified by immunohistochemistry, its differentiation into hepatoid morphology and its unique clinical course draw clinical attention. Among 300 gastric adenocarcinoma patients whose serum CEA and AFP were available for
analysis, we
have identified 14 case of adenocarcinoma with increases serum AFP(4.7%). Immunohistochemistry and detailed morphologic analysis were possible in 7 resectable cases. The other 7 cases were unresectable but clinical judgement based on patient's
history
and laboratory data made diagnosis possible. AFP, alpha-1 antitrypsin and CEA were positively stained in most cases in solid area and PAS was positive in all cases. In one case hCG was strongly stained and it showed no hepatoid differentiation.
It
suggests that AFP producing gastric adenocarcinomas are not always derived form hepatoid differentiation of the forgut. The positivity of AFP was not correlated to the serum level. However, serum AFP level was invariably decreased following
curative
resection of the stomach and bounced back up with recurrence. Liver was the most frequent site of metastasis in the type of carcinoma. 4 among 7 resectable cases and all 7 unresectable cases(11/14, 78.6%) show liver involvement at the time of
diagnosis
or some time after curative resection. In conclusion, gastric adenocarcinoma with increased serum AFP may be different from usual gastric adenocarcinomas in its clinical course as well as its pathogenesis. And Its poor prognosis may be attributed
to
predilection for metastasis, which should be watched carefully during follow-up.
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KEYWORD
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