Hepatoid adenocarcinoma of the stomach was defined in 1985 by Ishikura et al. We retrospectively analysed 12 cases of gastric hepatoid adenocarcinoma. Six cases were operated and diagnosed as this disease entity by pathologic examination of the
operated
specimen, and the other 6 cases were not operated but diagnosed by re-evaluation of preoperative endoscopic biopsy specimen with high serum alpha-fetoprotein(AFP) level. All of them were advanced gastric carcinoma with there were 7 cases of
synchronous
liver metastasis and 3 cases of metachronous liver metastasis. Microscopically, the tumor cells of hepatoid portion were polygonal or cuboidal in shape with abundant eosinophilic and granular cytoplasm. Most of the cases showed tumor emboli in
vessels
and lymphatics and lymph node metastases were found in all cases. This cancer is characterized by 1) no gross difference with typical gastric adenocarcinoma, 2) frequent tumor emboli in vessels and lymphatics, 3) high serum AFP level, 4) poor
prognosis
than typical gastric adenocarcinoma, and 5) frequent liver metastasis and venous thromosis, i.e., portal vein thrombosis. According to the clinical characteristics of this disease, we can suggest that immunohistochemical staining and more precise
precise evaluation of the endoscopically picked-up specimen and operated specimen are needed especially in cases of increased serum AFP level not to miss this disease. Overall, the evaluation of serum AFP level with abdominal ultrasonography is
mandatory for the best evaluation and treatment of patients bearing these tumors. Further studies are needed to search for more effective treatment modality including surgical and medical therapy.
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