A Case of Early Gastric Cancer Producing Alpha-fetoprotein

A 79-year-old woman was admitted to our hospital for surgical treatment of gastric cancer. A man-fist-size tumor was palpated in the left hypochondrial region. The serum AFP level was increased to 990 ng/ml. X-ray and endoscopic examinations of the stomach revealed a lesion with a shallow depression combined with an elevation (IIa + IIc type, Japanese classification of gastric carcinoma), on the posterior wall of the antrum and a protruded lesion on the subcardia. Although a round tumor was revealed by contrast medium in the subcardia of the stomach, liver metastasis was not demonstrated by X-ray examination. A regional lymph node along the lesser curvature of the stomach enlarged to 70mm in diameter, which was oppressing on the subcardia, was found intraoperatively. Distal gastrectomy with D2 lymph node dissection was performed. The main pathological feature of the gastric lesion was moderately differentiated adenocarcinoma which was limited to the submucosa of the stomach. Positive immunohistochemical staining of AFP was demonstrated in about 10% of the total amount of the cancer with eosinophilic granular cytoplasma. The serum AFP level decreased to normal after the operation. The prognosis of the patient with AFP-producing gastric cancer has been reported to be poor because of advance of the disease in most of the cases, but this patient is alive without recurrence 14 months after surgery.