Yibin Xie1, Zhonghai Zhao2, Peng Li1, Yang Wang1, Chunguang Guo1, Xiaoliang Wang3, Wei Tang4, Qian Liu1, Ning Lu3, Liyan Xue3, Dongbing Zhao1. 1. Department of Abdominal Surgical Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021, China. 2. Department of General Surgery, Beijing Puren Hospital Beijing 100062, China. 3. Department of Pathology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021, China. 4. Department of Diagnostic Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021, China.
Abstract
AIM: To document the clinicopathological characteristics and analyze the possible reasons for misdiagnosis or missed diagnosis of hepatoid adenocarcinoma of the stomach (HAS), using data from a single center. METHODS: We retrospectively analyzed 19 patients initially diagnosed as HAS and 7 patients initially diagnosed as common gastric cancer with high levels of serum α-fetoprotein (AFP). All had undergone surgical treatment, except 3 patients only had biopsies at our hospital. Immunohistochemistry for AFP and Hepatocyte antigen was performed. Final diagnosis for these 26 patients were made after HE and immunohistochemistry slides reviewed by 2 experienced pathologists. Prognostic factors were determined by univariate analysis. RESULTS: Nineteen cases were confirmed to be HAS. A total of 4 out of 19 cases initially diagnosed as HAS and 4 out of 7 cases initially diagnosed as common gastric adenocarcinoma were misdiagnosed/missed diagnosed, thus, the misdiagnosis/missed diagnosis rate was 30.8% (8/26). The incidence of HAS among gastric cancer in our center was 0.19% (19/9915). Sixteen (84.2%) patients showed T stages greater than T2, 12 (70.6%) patients had positive lymph nodes in 17 available patients and 3 (15.8%) of the patients with tumors presented liver metastasis at the time of diagnosis. Histologically, cytoplasmic staining types included 10 cases of eosinophilic, 1 case of clear, 5 cases of clear mixed with eosinophilic and 3 cases of basophilic. Fourteen (73.7%) patients expressed AFP, whereas only 6 (31.6%) were hepatocyte-positive. Univariate analysis showed that N stage (HR 2.429, P=0.007) and tumor AFP expression (HR 0.428, P=0.036) were significantly associated with disease-free survival. The median overall survival time was 12.0 months, and the median disease-free survival time was 7.0 months. Four (80%) of 5 N0 patients and 2 (50%) of 4 N1 patients survived without progression, but no N2-3 patients survived. CONCLUSION: HAS remains easily being misdiagnosed/missed diagnosed based on a pathological examination, probably because the condition is rare and has various cytoplasmic types. Although the survival rate for HAS is poor, a curative effect may be achieved for N0 or N1 cases.
AIM: To document the clinicopathological characteristics and analyze the possible reasons for misdiagnosis or missed diagnosis of hepatoid adenocarcinoma of the stomach (HAS), using data from a single center. METHODS: We retrospectively analyzed 19 patients initially diagnosed as HAS and 7 patients initially diagnosed as common gastric cancer with high levels of serum α-fetoprotein (AFP). All had undergone surgical treatment, except 3 patients only had biopsies at our hospital. Immunohistochemistry for AFP and Hepatocyte antigen was performed. Final diagnosis for these 26 patients were made after HE and immunohistochemistry slides reviewed by 2 experienced pathologists. Prognostic factors were determined by univariate analysis. RESULTS: Nineteen cases were confirmed to be HAS. A total of 4 out of 19 cases initially diagnosed as HAS and 4 out of 7 cases initially diagnosed as common gastric adenocarcinoma were misdiagnosed/missed diagnosed, thus, the misdiagnosis/missed diagnosis rate was 30.8% (8/26). The incidence of HAS among gastric cancer in our center was 0.19% (19/9915). Sixteen (84.2%) patients showed T stages greater than T2, 12 (70.6%) patients had positive lymph nodes in 17 available patients and 3 (15.8%) of the patients with tumors presented liver metastasis at the time of diagnosis. Histologically, cytoplasmic staining types included 10 cases of eosinophilic, 1 case of clear, 5 cases of clear mixed with eosinophilic and 3 cases of basophilic. Fourteen (73.7%) patients expressed AFP, whereas only 6 (31.6%) were hepatocyte-positive. Univariate analysis showed that N stage (HR 2.429, P=0.007) and tumorAFP expression (HR 0.428, P=0.036) were significantly associated with disease-free survival. The median overall survival time was 12.0 months, and the median disease-free survival time was 7.0 months. Four (80%) of 5 N0 patients and 2 (50%) of 4 N1 patients survived without progression, but no N2-3 patients survived. CONCLUSION: HAS remains easily being misdiagnosed/missed diagnosed based on a pathological examination, probably because the condition is rare and has various cytoplasmic types. Although the survival rate for HAS is poor, a curative effect may be achieved for N0 or N1 cases.
Authors: G Giustozzi; G Goracci; A Bufalari; A Lauro; R Cirocchi; C Boselli; A Bartoli; M Monacelli; M Giansanti; L Moggi Journal: J Exp Clin Cancer Res Date: 1999-12