case_images: PMC9427307_01
case_images: Preoperative findings and histopathological analysis of the resected specimen. Upper endoscopy revealing a semicircular type 2 tumor on the greater curvature of the gastric corpus that extends to the pylorus (a). Contrast-enhanced computed tomography depicting bulky thickening of the distal stomach wall, without invasion to the pancreas or ascites, lymph node or remote metastases, or liver tumors (hepatocellular carcinoma or metastatic liver tumor) (b). Open total gastrectomy, lymphadenectomy, and Roux-en-Y reconstruction were performed (c). The histopathological diagnosis was gastric cancer (pT2, N2, M0, stage IIB (Union for International Cancer Control TNM Classification of Malignant Tumors, 8th edition)) (d, e). Immunostaining of the primary tumor was positive for alpha-fetoprotein and negative for human epidermal growth factor receptor 2 (f, g, respectively).
case_images: CRIS2022-2700394.001.jpg
case_images: PMC9427307_01_CRIS2022-2700394.001.jpg
case_images: fig1
case_images: U/mL (reference range, 0-37 U/mL), respectively. Upper gastrointestinal endoscopy revealed an 11 x 5 cm semicircular Borrmann type 2 tumor on the greater curvature of the gastric corpus that extended to the pylorus (Figure 1(a)). The wall of the distal stomach was thickened on contrast-enhanced computed tomography (CE-CT); no signs of ascites, lymph node metastasis, remote metastasis, or tumor invasion was noted in the pancreas (Figure 1(b)). TNM Classification of Malignant Tumors, 8th edition)) (Figures 1(c)-1(e)). Immunostaining of the primary tumor was positive for AFP and negative for human epidermal growth factor receptor 2 (Figures 1(f) and 1(g)). The patient was treated with eight cycles of
case_images: Chronological trend of serum alpha-fetoprotein levels serum alpha-fetoprotein (AFP) levels was elevated and abruptly decreased after curative gastrectomy. Metachronous liver metastasis and increases in serum AFP levels were detected 3.5 years after the initial gastrectomy. After four cycles of CapeOX combination chemotherapy, the solitary liver lesion was diminished and serum AFP levels decreased to within normal limits. Abbreviations: ACT: adjuvant chemotherapy; AFP: alpha-fetoprotein; CapeOX: capecitabine/oxaliplatin.
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case_images: PMC9427307_01_CRIS2022-2700394.002.jpg
case_images: fig2
case_images: S-1 monotherapy (tegafur/gimeracil/oteracil) (120 mg/day on days 1-14, every 3 weeks) as an adjuvant chemotherapy. Serum AFP levels decreased to 3.5 ng/mL (Figure 2), and no recurrence was observed on blood tests every 3 months and CE-CT every 6 months over the 3-year surveillance period. However, serum AFP levels started to increase up to 19.6 ng/mL, 3.5 years after curative gastrectomy (Figure 2). The level of serum AFP decreased to within the normal range (5.6 ng/mL) (Figure 2).
case_images: Radiological findings following liver metastasis (segment 5/6) from AFP-producing gastric carcinoma contrast-enhanced computed tomography revealing a hypovascular nodule in segment 5/6 of the liver (a, b). T1- and T2-weighted MRI showing a low-signal nodule and slightly high signal, respectively; a 9 mm defect is observed with EOB-MRI (c-e). 18F-FDG PET/CT showing an abnormal accumulation of 18F-FDG (maximum standardized uptake value of 4.8) at the same point (f). The tumor was undetectable on EOB-MRI after four courses of CapeOX therapy; no accumulation was detected on PET/CT (g, h). Abbreviations: CapeOX: capecitabine/oxaliplatin; CT: computed tomography; EOB: gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid; MRI: magnetic resonance imaging; PET: positron emission tomography; 18F-FDG: 2-deoxy-2-[fluorine-18] fluoro-D-glucose.
case_images: CRIS2022-2700394.003.jpg
case_images: PMC9427307_01_CRIS2022-2700394.003.jpg
case_images: fig3
case_images: CE-CT revealed a hypovascular nodule in segment 5/6 of the liver (Figures 3(a) and 3(b)). A 9 mm nodule was observed on T1- and T2-weighted MRI; this nodule was categorized as a defect on EOB-MRI (Figures 3(c)-3(e)). Positron emission tomography with 2-deoxy-2-[18F] fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) showed an abnormal accumulation of 18F-fluorodeoxyglucose (FDG) (maximum standardized uptake value of 4.8) at the same point (Figure 3(f)). The tumor was not detected on CE-CT, EOB-MRI, or contrast-enhanced ultrasonography using perflubutane (CE-US) following treatment; no accumulation of 18F-FDG was observed by 18F-FDG PET/CT (Figures 3(g) and 3(h)).