-Report on Experiments and Clinical Cases-

Resection of Liver Metastases from an α-fetoprotein-producing Gastric Cancer

Tomohiro Kanda¹, Hiroshi Yoshida¹, Yasuhiro Mamada¹, Nobuhiko Taniai¹, Youichi Kawano¹, Yoshiaki Mizuguchi¹, Tetsuya Shimizu¹, Tsubasa Takahashi¹, Junji Ueda¹, Shunji Kato¹, Koho Akimaru¹, Takashi Tajiri¹ and Yuh Fukuda²

¹Surgery for Organ Function and Biological Regulation, Nippon Medical School, Graduate School of Medicine
²Department of Analytic Human Pathology, Nippon Medical School, Nippon Medical School, Graduate School of Medicine

We describe successful resection of rapidly enlarging liver metastases from an α-fetoprotein-producing gastric cancer, as these usually carry a dismal prognosis.
A 68-year-old woman underwent distal gastrectomy for an α-fetoprotein-producing gastric cancer without liver metastasis. The tumor was a moderately differentiated tubular adenocarcinoma with invasion of the muscularis propria. Venous and lymphatic invasion were noted, as was metastasis to lymph nodes along the greater curvature. Serum α-fetoprotein was 331 ng/mL before gastrectomy, decreasing to 18.6 ng/mL by postoperative day 28. At 2 months after operation, computed tomography detected no metastasis, but at 4 months α-fetoprotein increased to 2,190 ng/mL, and at 5 months liver tumors were detected by ultrasonography and computed tomography. Serum α-fetoprotein increased to 5,673 ng/mL, and serum PIVKA2 concentration was 18 mAU/ml just before operation. Extended left hepatectomy was performed. The resected specimen of segment 4 contained two well-defined tumors, measuring 5×4 cm and 2×2 cm, while that of segment 5 contained a similar-appearing tumor measuring 2×2 cm. The resected tumors had the same histologic appearance as the previously removed gastric cancer. The tumor cells were immunohistochemically reactive for α-fetoprotein. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. Serum α-fetoprotein decreased to 20 ng/mL by postoperative day 15, and to 5 ng/mL by 2 months after operation. For 5 months since operation, no recurrence has become evident, and serum α-fetoprotein has remained within the normal range.

J Nippon Med Sch 2005; 72: 66-70

Keywords
gastric carcinoma, α-fetoprotein, metastatic liver tumor, hepatectomy

Correspondence to
Hiroshi Yoshida, MD, First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
hiroshiy@nms.ac.jp

Received, August 17, 2004
Accepted, October 5, 2004