Clinicopathologial features of gastric hepatoid adenocarcinoma

Background: Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by hepatocellular carcinoma-like histology. As details of this disease remain unknown, the aim of this study was to evaluate the clinicopathological features of GHA. Methods: From January 2001 to December 2010, 4563 patients were diagnosed with primary gastric cancer at Chang Gung Memorial Hospital, Linkou Medical Center. Ten (0.22%) of these patients were diagnosed with GHA. The clinicopathological characteristics of these patients were collected retrospectively. Results: The median age at diagnosis was 65.5 years, and six patients (60%) were male. Seven patients had lymph node metastasis and five had distant metastasis, with the liver as the most common site (four cases). Serum alpha-fetoprotein (AFP) levels were elevated in seven of eight patients (median: 359.2 ng/ml; range: 4.3-6535.6 ng/ml). Endoscopically, six tumors were classified as Borrmann's type III cancer with the appearance of fungating mass lesion with a purple, berry-like surface. Of the five patients without distant metastasis, all received curative-intent surgery and four received adjuvant chemotherapy. Four patients with distant metastasis received either palliative operation or chemotherapy, and one patient received neither operation nor chemotherapy due to a poor performance status. The median survival time was 7.2 months (range: 0.7-131.8 months), and the 5-year survival rate was 20%. There was survival benefit in the chemotherapy groups. Conclusions: GHA is a rare subtype of gastric cancer which is prone to lymph node and liver metastasis. Most GHAs appear as Borrmann's type III fungating mass lesion with a purple, berry-like surface. Although the prognosis of advanced stage GHA is poor, chemotherapy might provide some benefit.