[A Surgical Case of AFP-Producing Gastric Cancer Discovered by Rupture of Liver Metastatic Lesion].

A 57-year-old man visited our hospital with right hypochondralgia. Abdominal contrast CT showed a 10 cm sized mass in S6-7of the liver and abdominal hemorrhage areas. The tumor showed extrahepatic growth. Blood a-fetoprotein(AFP)was high at 4,447.9ng/mL. Hemostasis was performed through emergency transcatheter arterial embolization. At a later date, upper gastrointestinal endoscopy showed a 20 mm sized type 2 lesion in the gastric corpus. Therefore, we performed distal gastrectomy and right hepatic lobectomy. In histopathological findings, the gastric lesion showed identified as a hepatoid adenocarcinoma, which was positive for AFP protein. The liver lesion was negative for AFP protein, but was similar to hepatoid adenocarcinoma, and no fibrosis was observed in the background liver. Therefore, we diagnosed the tumor as a liver metastasis of AFP-producing gastric cancer. On postoperative day 31, CT showed a metastatic lesion in the S1 of the liver and ascites. Chemotherapy was not successful, and the patient died on postoperative day 75. The resection rate of metastatic liver tumor in AFP-producing gastric cancer is low. This is the second case in Japan, wherein a surgery was performed for a ruptured liver metastatic lesion.