• Journal of Gastric Cancer
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• v.5 no.2
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• pp.127-132
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• 2005

A hepatoid adenocarcinoma of stomach, a subtype of gastric cancr, is characterized by a histologic resemblance to a hepatocellular carcinoma and $\alpha$-feto protein production. Another feature is early metastasis to the liver and lymph nodes, thus revealing a poor prognosis. We report a case of a hepatoid adenocarcinoma of the stomach with liver metastasis. A 52-year-old male visited our hospital with a chief complaint of indigestion. Gastroscopic examination showed a Borrmann type-II lesion on the lesser curvature of the antrum. The CT scan showed a suspected advanced gastric cancer with liver metastasis. The serum AFP level was 123 ng/ml. A radical subtotal gastrectomy and a right hemihepatectomy were performed simultaneously. Pathologic examination confirmed the lesion to be confined to the submucosa. The gastric lesion was a hepatoid adenocarcinoma, and the hepatic lesion was a metastatic adenocarcinoma from the stomach. Therefore, he was classified as having stage IV (T1N1M1) gastric cancer. In cases of a hepatoid adenocarcinoma of the stomach, even patients with early gastric cancer can be staged into the poor prognostic group.

• Journal of Gastric Cancer
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• v.6 no.4
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• pp.263-269
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• 2006

Purpose: The aim of this study was to investigate the causes of under-staging in patients with advanced gastric cancer that was proven to be unresectable after a laparotomy. Materials and Methods: We retrospectively analyzed 25 gastric cancer patients who had undergone a diagnostic laparotomy between 2001 and 2005. For the preoperative evaluation, spiral CT and multidetector-row CT were performed. We analyzed the clinicopathologic features of patients and compared the image findings and the results of surgery. The causes of under-staging were divided into 3 groups; patient factor, CT factor, and interpretation factor. Results: Grossly, there were 12 cases of Borrmann type-III tumors and 13 cases of Borrmann type-IV tumors. The most frequent histologic type was poorly differentiated adenocarcinomas (8 cases) and signet ring cell carcinomas (7 cases). There were 13 cases of adjacent organ invasion, and the pancreas was the most frequently invaded organ (9 cases). There were 17 cases of peritoneal metastasis, and 3 cases of distant lymph node metastasis. For the cause of under-staging, there were four cases of patient factor, 19 cases of interpretation factor, and 9 cases of CT factor. In three cases, the cause of under-staging could not be identified. Conclusion: CT interpretation factor was the most frequent cause of under-staging in the preoperative diagnosis with gastric cancer patients. Therefore, more cautious CT interpretation is necessary to avoid unnecessary laparotomies in gastric cancer patients.

• The Korean Journal of Nuclear Medicine
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• v.35 no.5
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• pp.301-312
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• 2001

Purpose: Stomach cancer is one of the most common malignancies in Korea, but there is no report on FDG PET in patients with stomach cancer. We observed findings of FDG PET in patients with stomach cancer. Materials and Methods: In 13 patients with pre-operative stomach cancer, PET and CT were performed. Primary lesion and regional lymph nodes detection were aualyzed. Correlation between FDG uptake ratio and each prognostic factor of primary lesion was analyzed. In 19 patients diagnosed as recurrence or displaying suspicious symptoms, conventional work up including tumor marker and PET were performed. Recurrence detection of anastomotic site, distant metastasis, and tumor marker elevation were analyzed. Results: Sensitivity for primary lesion detection was 83.3% (CT 71.4%) and two submucosal lesions were undetected. FDG uptake ratio was variable and had no correlation with invasion-depth, size, Borrmann type, staging and differentiation. Sensitivity for regional lymph node detection was 58.3% (CT 58.3%) and the lesions less than 1cm were undetected. Sensitivity for recurrence detection was 100% but there were three false positives. Sensitivity for distant metastasis detection was 64.3% and significantly higher than that of conventional work-up (21.4%). Average of tumor marker level in patients who were confirmed as recurrence was higher than false positive. Conclusion: PET is more useful than conventional work up in distant metastasis detection when recurrence is suspected. In pre-operative stomach cancer, PET is comparable to CT for detection of primary lesion and regional lymph node metastasis and detection of distant metastasis requires further study.