1Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
2Department of Pathology, Hammoud Hospital University Medical Center, Saida, Lebanon
3Faculty of Medicine, Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
4Faculty of Medicine, American University of Beirut, Beirut, Lebanon
5Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
6Faculty of Medical Science, Department of Hematology-Oncology, Saint Joseph University, Beirut, Lebanon
7Department of Hematology-Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon
Edited by: Arun Chaudhury, GIM Foundation, United States
Reviewed by: Madhukar Reddy Kasarla, Parkway Surgical and Cardiovascular Hospital, United States; Kiran Kumar Panuganti, Texas Health Resources Foundation, United States; Sumit Fogla, William Beaumont Hospital, United States; Sudheer Reddy Koyagura, Northwest Medical Center, United States; Sunil Kumar, Neshoba County General Hospital and Nursing Home, United States
*Correspondence: Najla Fakhruddin, bl.ude.bua@12fn
Fadi Farhat, firstname.lastname@example.org
Specialty section: This article was submitted to Gastroenterology, a section of the journal Frontiers in Medicine.
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 Her2 amplification and overexpression, association with p53 mutations, but no association with KRAS mutations. EGFR and BRAF 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 Her2 overexpression by immunohistochemistry (IHC), but no EGFR, KRAS, or BRAF 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.
Keywords: hepatoid adenocarcinoma, stomach, alpha fetoprotein, liver metastasis, case report