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Sukumaran R, Mathews A, Radhakrishnan N. Hepatic Metastasis from Hepatoid Adenocarcinoma of the Stomach Mimicking Hepatocellular Carcinoma: Diagnostic Challenge. CLINICAL CANCER INVESTIGATION JOURNAL 2022. [DOI: 10.51847/eddehtlu0r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Xia R, Zhou Y, Wang Y, Yuan J, Ma X. Hepatoid Adenocarcinoma of the Stomach: Current Perspectives and New Developments. Front Oncol 2021; 11:633916. [PMID: 33912455 PMCID: PMC8071951 DOI: 10.3389/fonc.2021.633916] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/09/2021] [Indexed: 02/05/2023] Open
Abstract
Hepatoid adenocarcinoma of the stomach (HAS) is a rare malignant tumor, accounting for only 0.17-15% of gastric cancers. Patients are often diagnosed at an advanced disease stage, and their symptoms are similar to conventional gastric cancer (CGC) without specific clinical manifestation. Morphologically, HAC has identical morphology and immunophenotype compared to hepatocellular carcinoma (HCC). This is considered to be an underestimation in diagnosis due to its rare incidence, and no consensus is reached regarding therapy. HAS generally presents with more aggressive behavior and worse prognosis than CGC. The present review summarizes the current literature and relevant knowledge to elaborate on the epidemic, potential mechanisms, clinical manifestations, diagnosis, management, and prognosis to help clinicians accurately diagnose and treat this malignant tumor.
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Affiliation(s)
- Ruolan Xia
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuqing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiaming Yuan
- West China School of Medicine, Sichuan University, Chengdu, China
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Obana A, Komatsu N, Aiba K, Nakanishi S, Abe M, Yamaguchi T, Hayashi M, Obi H, Koyama M, Hashimoto S. A case of long-term survival after splenectomy for solitary splenic metastasis from gastric cancer. World J Surg Oncol 2020; 18:250. [PMID: 32950063 PMCID: PMC7502201 DOI: 10.1186/s12957-020-02024-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Very rarely does a splenic solitary metastasis arise from a gastric carcinoma because splenic metastasis is usually seen in association with widespread visceral metastasis. Splenectomy is considered to be a curative treatment; however, long-term prognosis after splenectomy has scarcely been reported. We report a case of a metachronous and solitary metastasis to the spleen from gastric cancer in which the patient achieved 5-year recurrence-free survival after splenectomy. Case presentation An 84-year-old man underwent an open total gastrectomy involving D1+ lymph nodes dissection for gastric cancer located in the cardia (pT3N1M0, pStage IIB). Eighteen months later, a 2-cm solitary hypodense lesion was detected in the spleen by computed tomography (CT). Twenty-three months later, the serum carcinoembryonic antigen (CEA) value elevated to 19.9 ng/ml, and abdominal CT revealed an increase in tumor size to 5 cm. Positron-emission tomography (PET)-CT revealed intense 18F-2-deoxy-2-fluoro-glucose (FDG) uptake in the spleen without the involvement of other organs and lymph nodes. We diagnosed him with solitary splenic metastasis from gastric cancer and performed a splenectomy 26 months after the first surgery. Histological examination revealed that the splenic tumor was a moderately differentiated adenocarcinoma, which was very similar to the primary gastric tumor; the lesion was diagnosed as a metastatic tumor from the previous gastric carcinoma. The patient remains healthy to date without recurrence, 5 years after the splenectomy. Conclusion We experienced a case of a solitary splenic metastasis from gastric cancer in which 5-year recurrence-free survival was achieved after splenectomy. To determine the surgical indication in patients with splenic metastasis, it is important to differentiate between a solitary lesion or multiple metastasis. Especially, occult metastasis should be excluded by means of several months of follow-up with imaging tests and systemic FDG-PET surveys before splenectomy.
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Affiliation(s)
- Ayato Obana
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan. .,Department of General Surgery, Kashiwa Kousei General Hospital, 617, Shikoda, Kashiwa, Chiba, 277-8551, Japan.
| | - Nobuo Komatsu
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Kazuma Aiba
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Shinya Nakanishi
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Masakazu Abe
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | | | - Masahiro Hayashi
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Hayato Obi
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Masamichi Koyama
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
| | - Shinichi Hashimoto
- Department of Surgery, Asama Nanroku Komoro Medical Center, Nagano, Japan
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Dragnev NC, Wong SL. Do we CARE about the quality of case reports? A systematic assessment. J Surg Res 2018; 231:428-433. [PMID: 30278963 DOI: 10.1016/j.jss.2018.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/16/2018] [Accepted: 07/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical case reports are important sources of information on the identification and treatment of new or rare diseases. The CAse REport (CARE) Statement and Checklist represents consensus-based guidelines for clinical case reports. How well case reports adhere to these guidelines is unknown. MATERIAL AND METHODS A systematic PubMed and OVID search was used to identify case reports on isolated splenic metastasis from 2007 to 2017 in English language journals. MeSH search terms included "(isolated splenic metastasis OR solitary splenic metastasis) AND case report." We retrieved 79 articles and 55 directly addressed the topic of interest. Each was scored dichotomously using the 13 categories with 36 item descriptors on the CARE checklist. RESULTS Of the 55 case reports, none fully followed the CARE guidelines; only 56.4% met 23 descriptors and none had more than 29 of 36 descriptors. Patient symptoms were not described in 40.0%, and in 47.3%, the abstract did not identify the main outcomes. All reports included patient's age and diagnostic methods. Most case reports reported the type of intervention (96.4%) and effect of the intervention (96.4%). None included patient-assessed outcomes or the patient's perspective. Only 49.1% included strengths and limitations of patient management, stating that the most effective treatment is unknown. CONCLUSIONS None of the case reports on isolated splenic metastasis completely followed the CARE guidelines. Most reports did cover diagnostic workup and therapeutic interventions and gave a summary of the literature. Higher quality case reports would be useful in facilitating recognition of rare disease processes and informing clinical practice.
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Affiliation(s)
| | - Sandra L Wong
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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Fakhruddin N, Bahmad HF, Aridi T, Yammine Y, Mahfouz R, Boulos F, Awada A, Farhat F. Hepatoid Adenocarcinoma of the Stomach: A Challenging Diagnostic and Therapeutic Disease through a Case Report and Review of the Literature. Front Med (Lausanne) 2017; 4:164. [PMID: 29034239 PMCID: PMC5627014 DOI: 10.3389/fmed.2017.00164] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/19/2017] [Indexed: 12/28/2022] Open
Abstract
Hepatoid adenocarcinoma of the stomach (HAS) is a rare aggressive tumor with hepatocellular differentiation. HAS often produces alpha fetoprotein (AFP) and metastasizes to the lymph nodes and the liver. Molecular studies revealed Her2 amplification and overexpression, association with p53 mutations, but no association with KRAS mutations. EGFR and BRAF mutations have not yet been evaluated in hepatoid carcinoma of the stomach so far. Hereby, we present a case of a 41-year-old female patient with HAS with high AFP level and liver metastases. Molecular analysis revealed Her2 overexpression by immunohistochemistry (IHC), but no EGFR, KRAS, or BRAF mutations were detected. The patient underwent chemotherapy type DCX (docetaxel, cisplatinum, and capecitabine) every 3 weeks with partial response after two cycles, maintained for eight cycles, and then was on maintenance therapy with trastuzumab for 7 months before relapsing and dying 18 months from the day of diagnosis. Conclusively, HAS may be misdiagnosed as hepatocellular carcinoma; therefore, it should be considered in the differential diagnosis of multiple hepatic nodules with high AFP and no history of hepatitis, liver fibrosis or cirrhosis.
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Affiliation(s)
- Najla Fakhruddin
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Pathology, Hammoud Hospital University Medical Center, Saida, Lebanon
| | - Hisham F Bahmad
- Faculty of Medicine, Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Tarek Aridi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Yammine
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Fadi Farhat
- Faculty of Medical Science, Department of Hematology-Oncology, Saint Joseph University, Beirut, Lebanon.,Department of Hematology-Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon
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Namikawa T, Kawanishi Y, Fujisawa K, Munekage E, Munekage M, Sugase T, Maeda H, Kitagawa H, Kumon T, Hiroi M, Kobayashi M, Hanazaki K. Metachronous solitary splenic metastasis arising from early gastric cancer: a case report and literature review. BMC Surg 2017; 17:96. [PMID: 28851346 PMCID: PMC5576276 DOI: 10.1186/s12893-017-0292-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/24/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The metastasis of malignant tumors to the spleen is rare, and only a small percentage of cases can be treated surgically, as splenic metastases generally occur in the context of multivisceral metastatic cancer at a terminal stage. We report a rare case of metachronous solitary splenic metastasis arising from early gastric cancer. CASE PRESENTATION A 75-year-old man was initially referred to our hospital for examination of gastric cancer, diagnosed at a medical check-up. Esophagogastroduodenoscopy showed a slightly elevated lesion with a central irregular depression in the upper-third of the stomach. Biopsy specimens of the lesion showed a moderately-differentiated adenocarcinoma, and abdominal computed tomography showed no evidence of distant metastases. Endoscopic submucosal dissection was performed, with histological confirmation of a moderately-differentiated adenocarcinoma invading the submucosal layer. The patient subsequently underwent laparoscopic total gastrectomy with regional lymph node dissection, resulting in no residual carcinoma and no lymph node metastasis. Computed tomography, 28 months later, showed a well-defined mass measuring 4.2 cm in diameter in the spleen, and the patient underwent a splenectomy, since there was no evidence of further metastatic lesions in any other organs. Histological examination confirmed the diagnosis of a poorly-differentiated adenocarcinoma originating from the previous gastric cancer. The patient was alive 2 months after surgical resection of the splenic metastasis without any recurrence. CONCLUSION To the best of our knowledge, this is only the second case of a solitary splenic metastasis from early gastric cancer to be reported in the English literature. The present case suggests surgical resection may be the preferred treatment of choice for patients with a solitary splenic metastasis from gastric cancer.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Yasuhiro Kawanishi
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | | | - Eri Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Takahito Sugase
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tatsuya Kumon
- Department of Surgery, Noichi Central Hospital, Kochi, Japan
| | - Makoto Hiroi
- Department of Pathology, Kochi Medical School, Kochi, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan.,Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Wang FQ, Lu Q, Yan J, Peng YY, Xie CR, Su YJ, Zhou JY, Wang BL, Zhao WX, Wang XM, Bie P, Yin ZY. Ex vivo hepatectomy and partial liver autotransplantation for hepatoid adenocarcinoma: A case report. Oncol Lett 2015; 9:2199-2204. [PMID: 26137040 DOI: 10.3892/ol.2015.3041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 02/26/2015] [Indexed: 01/16/2023] Open
Abstract
We previously reported the case of a 56-year-old male who underwent surgical treatment for gastric hepatoid adenocarcinoma and splenic metastasis. The present study reports the case of the same patient who underwent successful ex vivo hepatectomy and partial liver autotransplantation. Computed tomography scans demonstrated that the tumor was located in the left and caudate lobes of the liver, with hepatic vein and inferior vena cava involvement, and right portal vein compression. To clarify the association between the vessels and the tumor, a three-dimensional imaging technique was used to reconstruct the liver architecture. During the surgery, the whole liver was removed with the retrohepatic vena cava, which was replaced with a prosthetic graft without a veno-venous bypass; a portacaval shunt for the anhepatic phase was performed simultaneously. The surgery lasted 9 h, and the anhepatic phase lasted 4 h. Blood loss during the surgery was recorded at 1,500 ml. The time taken for recovery was 21 days post-surgery, and at 20 months, the patient was disease-free. To the best of our knowledge, this is the first case of ex vivo liver resection performed for hepatic metastasis of hepatoid adenocarcinoma to be reported.
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Affiliation(s)
- Fu-Qiang Wang
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
| | - Qian Lu
- Department of Hepatobiliary Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, P.R. China
| | - Jun Yan
- Department of Hepatobiliary Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, P.R. China
| | - You-Yuan Peng
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
| | - Cheng-Rong Xie
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
| | - Yong-Jie Su
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
| | - Jian-Yin Zhou
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
| | - Bo-Liang Wang
- School of Information Science and Technology, Xiamen University, Xiamen, Fujian, P.R. China
| | - Wen-Xiu Zhao
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
| | - Xiao-Min Wang
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
| | - Ping Bie
- Department of Hepatobiliary Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, P.R. China
| | - Zhen-Yu Yin
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian, P.R. China
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Yamane H, Fukuda N, Nishino K, Yoshida K, Ochi N, Yamagishi T, Honda Y, Kawamoto H, Monobe Y, Mimura H, Naomoto Y, Takigawa N. Non-occlusive mesenteric ischemia after splenic metastasectomy for small-cell lung cancer. Intern Med 2015; 54:743-7. [PMID: 25832935 DOI: 10.2169/internalmedicine.54.3545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man presented with severe abdominal pain. Seven months earlier, he had received systemic chemotherapy for small-cell lung cancer with solitary metastasis to the spleen, followed by splenectomy. Abdominal computed tomography and abdominal arterial angiography showed diffuse ischemia of the mesenteric artery without apparent occlusion. The patient also suffered from septicemia caused by Enterococcus faecium. Therefore, a diagnosis of non-occlusive mesenteric ischemia (NOMI) induced by septicemia was supposed. Although treatment with antibiotics and papaverine hydrochloride was administered and the necrotic tissue in the intestinal tract was resected, the patient died. Physicians should be aware that patients undergoing splenectomy are likely to be affected by septicemia, which may subsequently induce NOMI.
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Affiliation(s)
- Hiromichi Yamane
- Department of General Internal Medicine 4, Kawasaki Medical School, Japan
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