Case Report
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World J Hepatol. Jul 27, 2013; 5(7): 398-403
Published online Jul 27, 2013. doi: 10.4254/wjh.v5.i7.398
An isolate alpha-fetoprotein producing gastric cancer liver metastasis emerged in a patient previously affected by radiation induced liver disease
Vincenzo Cardinale, Gianmaria De Filippis, Alessandro Corsi, Augusto La Penna, Michele Rossi, Carlo Catalano, Paolo Bianco, Adriano De Santis, Domenico Alvaro
Vincenzo Cardinale, Domenico Alvaro, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Rome, Italy
Gianmaria De Filippis, Carlo Catalano, Department of Radiology, Sapienza University of Rome, 00185 Rome, Italy
Alessandro Corsi, Paolo Bianco, Department of Molecular Science, Sapienza University of Rome, 00185 Rome, Italy
Augusto La Penna, Adriano De Santis, Department of Clinical Medicine, Sapienza University of Rome, 00185 Rome, Italy
Michele Rossi, Department of Radiology, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
Author contributions: Cardinale V and Alvaro D provided substantial contributions to the conception and design, drafting the article and revising final approval of the version to be published; De Filippis G, Rossi M and Catalano C provided the radiological figures selection and preparation; Corsi A and Bianco P provided pathological analysis, histology figure preparation and text editing; La Penna A and De Santis A provided clinical records and contributions to article design and editing; and all authors read and approved the final manuscript.
Correspondence to: Domenico Alvaro, MD, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Viale dell’Università 37, 00185 Rome, Italy. domenico.alvaro@uniroma1.it
Telephone: +39-6-49972052 Fax: +39-6-4453319
Received: July 8, 2011
Revised: November 5, 2011
Accepted: November 14, 2012
Published online: July 27, 2013
Abstract

We report a case of an isolated hepatic neoplasia which originated in a site of the liver previously affected by radiation induced liver disease (RILD) in a patient resected for gastric cancer and referred to us for high serum alpha-fetoprotein (AFP) levels. This case challenged us in distiguishing, even histologically, between primary liver cancer and AFP producing gastric cancer metastasis. Only a panel of immunohistochemical markers allowed the definitive diagnosis of liver metastasis of endodermal stem cell-derived and AFP producing gastric cancer. We discuss the criteria for a differential diagnosis, as well as the possible link between RILD and emergence of liver neoplasia.

Keywords: Alpha-fetoprotein producing gastric cancer, Hepatoid adenocarcinoma, Liver metastasization, Radiation induced liver disease