A CASE OF AFP-PRODUCING GASTRIC CANCER METASTASIZED TO THE LIVER, RESULTING IN AN INTRAHEPATIC EMBOLUS OF A TUMOR OF THE PORTAL VEIN

We experienced a case of AFP-producing gastric cancer with a downhill course in a short period. Although the primary lesion was early gastric cancer limited to the submucosa (sm), it resulted in marked liver metasasis which resulted in an embolus of a tumor of the portal vein which was almost indistinguishable from primary hepatoma. This occurred soon after operation.The patient was a 55-year-old man, in whom gastrectomy was undertaken on the portal side of gastric cancer of the pyloric vestibule. Pathological examination revealed early sm gastric cancer and a chestnut-sized metastasis in the 6th lymphnode. The patient came six months after the operation with a pain in the right hypochondrial region. Abdominal CT revealed many low density areas which were suggestive of liver metastasis, and arteriography and ultrasonography revealed an embolus of a tumor of the portal vein, a characteristic of primary hepatoma. On that occasion, the serum AFP level was abnormally high, 39, 0000 ng/ml. Re-operation was performed to form a reservoir for injection of anticancerous agents, but the operation was restricted to excision of the hepatic tumor alone because of tumor infiltration. The relation at the initial operation between a lesion gastric cancer lesion and the 6th lymph node was studied by immunohistological staining (ABC method). The presence of AFP was demonstrated in all lesions, providing a definite diagnosis of the lesion of hepatic tumor as a metastasis of gastric cancer.