AUTHOR=Fakhruddin Najla , Bahmad Hisham F. , Aridi Tarek , Yammine Yara , Mahfouz Rami , Boulos Fouad , Awada Ahmad , Farhat Fadi 

TITLE=Hepatoid Adenocarcinoma of the Stomach: A Challenging Diagnostic and Therapeutic Disease through a Case Report and Review of the Literature

JOURNAL=Frontiers in Medicine

VOLUME=4

YEAR=2017

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2017.00164

DOI=10.3389/fmed.2017.00164

ISSN=2296-858X

ABSTRACT=<p>Hepatoid adenocarcinoma of the stomach (HAS) is a rare aggressive tumor with hepatocellular differentiation. HAS often produces alpha fetoprotein (AFP) and metastasizes to the lymph nodes and the liver. Molecular studies revealed <italic>Her2</italic> amplification and overexpression, association with <italic>p53</italic> mutations, but no association with <italic>KRAS</italic> mutations. <italic>EGFR</italic> and <italic>BRAF</italic> mutations have not yet been evaluated in hepatoid carcinoma of the stomach so far. Hereby, we present a case of a 41-year-old female patient with HAS with high AFP level and liver metastases. Molecular analysis revealed <italic>Her2</italic> overexpression by immunohistochemistry (IHC), but no <italic>EGFR, KRAS</italic>, or <italic>BRAF</italic> mutations were detected. The patient underwent chemotherapy type DCX (docetaxel, cisplatinum, and capecitabine) every 3 weeks with partial response after two cycles, maintained for eight cycles, and then was on maintenance therapy with trastuzumab for 7 months before relapsing and dying 18 months from the day of diagnosis. Conclusively, HAS may be misdiagnosed as hepatocellular carcinoma; therefore, it should be considered in the differential diagnosis of multiple hepatic nodules with high AFP and no history of hepatitis, liver fibrosis or cirrhosis.</p>