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A case of early gastric cancer producing alpha fetoprotein associated with gastric anisakiasis



A case of early gastric cancer producing alpha fetoprotein associated with gastric anisakiasis



Gastroenterological Endoscopy 34(3): 576-580



A 41-year-old man was admitted to our hospital because of gastric cancer. X-ray and endoscopic examination revealed a protruded lesion with irregular surface and central depression on the lesser curvature of the upper body (Figure 1, 2). Except for a slightly high 23 ng/ml serum AFP, no abnormal findings were noted on blood biochemistry, abdominal ultrasonography and computed tomography. Total gastrectomy was carried out and no liver metastasis were found. AFP level became to normal range (5 ng/ml) after operation. On the resected specimen, a Borrmann type 2 like protruded lesion measuring 2.8.times. 2.8 cm was noted on the anterior aspect of the lesser curvature of the upper body (Figure 3). Histological findings in the gastric cancer showed papillary clear adenocarcinoma mixed with hepatoid carcinoma and massive invasion to the submucosal layer (Figure 4, 5). Lymph nodes metastasis were noted. Eosinophilic granuloma which was formed by the infestation of a laval anisakis was found in the gastric mucosa of the posterior wall (Figure 6). The localization of AFP with ABC method was immunohistochemically demonstrated in the cytoplasm of the primary lesion and the metastatic lesions of the regional lymph nodes (Figures 7). Early gastric cancer producing AFP is rare. Only 6 reported cases of early gastric cancer with immunohistochemical localization of AFP in which a preoperative serum AFP level of more than 20 ng/ml became normal after gastrectomy were reviewed in Japan (Table 1).

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