Hepatoid adenocarcinoma of stomach - a morphological curiosity

Hepatoid adenocarcinoma is a rare histological form of gastric cancer with a poor prognosis. We describe a 53-yearold woman who presented to the surgical gastroenterology outpatient department with a history of abdominal pain, vomiting and loss of appetite for one month. Laboratory investigations revealed anaemia (haemoglobin 5.6 g/dL). On gastrointestinal endoscopy, an ulceroproliferative growth was seen in the pylorus with gastric outlet obstruction. Endoscopic biopsy was suggestive of a well differentiated adenocarcinoma. Computed tomography of abdomen revealed irregular circumferential thickening of pylorus with perigastric and common hepatic nodes without distant metastasis. Patient underwent radical subtotal gastrectomy. The final histopathology was reported as hepatoid adenocarcinoma. Further immunohistochemistry with alpha-foetoprotein showed intense cytoplasmic positivity. She was treated with adjuvant Macdonald regimen. She developed liver metastasis eight months after surgery and received palliative chemotherapy. She died 13 months after surgery. Our experience and previous reports suggest that hepatoid adenocarcinoma is an aggressive cancer. Radical surgery and chemotherapy still remain the main stay of treatment.