Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2015; 21(48): 13524-13531
Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13524
Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings
Yang-Yu Lin, Chien-Ming Chen, Yu-Hsiu Huang, Cheng-Yu Lin, Sung-Yu Chu, Ming-Yi Hsu, Kuang-Tse Pan, Jeng-Hwei Tseng
Yang-Yu Lin, Chien-Ming Chen, Sung-Yu Chu, Ming-Yi Hsu, Kuang-Tse Pan, Jeng-Hwei Tseng, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan 333, Taiwan
Yu-Hsiu Huang, Department of Pathology, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan 333, Taiwan
Cheng-Yu Lin, Department of Gastroenterology, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan 333, Taiwan
Author contributions: Lin YY and Chen CM collected and analyzed the data, and drafted the manuscript; Huang YH reviewed the pathological findings; Lin CY provided the clinical data and followed up the patients; Chu SY and Hsu MY revised the manuscript for important intellectual content; Pan KT and Tseng JH designed and supervised the study.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Chang Gung Memorial Hospital.
Informed consent statement: The need for patient informed consent was waived because of the retrospective and anonymous nature of this study.
Conflict-of-interest statement: There is not any conflict-of-interest problem in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jeng-Hwei Tseng, MD, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan County 333, Taiwan. ma0389@cgmh.org.tw
Telephone: +886-33281200-2575 Fax: +886-33971936
Received: June 20, 2015
Peer-review started: June 25, 2015
First decision: July 19, 2015
Revised: August 7, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 28, 2015
Processing time: 187 Days and 5.2 Hours
Abstract

AIM: To evaluate the dynamic computed tomography (CT) findings of liver metastasis from hepatoid adenocarcinoma of the stomach (HAS) and compared them with hepatocellular carcinoma (HCC).

METHODS: Between January 2000 and January 2015, 8 patients with pathologically proven HAS and liver metastases were enrolled. Basic tumor status was evaluated for the primary tumor location and metastatic sites. The CT findings of the liver metastases were analyzed for tumor number and size, presence of tumor necrosis, hemorrhage, venous tumor thrombosis, and dynamic enhancing pattern.

RESULTS: The body and antrum were the most common site for primary HAS (n = 7), and observed metastatic sites included the liver (n = 8), lymph nodes (n = 7), peritoneum (n = 4), and lung (n = 2). Most of the liver metastases exhibited tumor necrosis regardless of tumor size. By contrast, tumor hemorrhage was observed only in liver lesions larger than 5 cm (n = 4). Three patterns of venous tumor thrombosis were identified: direct venous invasion by the primary HAS (n = 1), direct venous invasion by the liver metastases (n = 7), and isolated portal vein tumor thrombosis (n = 2). Dynamic CT revealed arterial hyperattenuation and late phase washout in all the liver metastases.

CONCLUSION: On dynamic CT, liver metastasis from HAS shared many imaging similarities with HCC. For liver nodules, the presence of isolated portal vein tumor thrombosis and a tendency for tumor necrosis are imaging clues that suggest the diagnosis of HAS.

Keywords: Computed tomography; Liver; Hepatoid adenocarcinoma; Hepatocellular carcinoma; Stomach

Core tip: Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer with clinicopathological presentation mimicking hepatocellular carcinoma (HCC). The high similarity between the two diseases makes the differential diagnosis challenging, especially when the primary tumor is unknown, and the liver nodules are the only initial finding. In the present study, identical dynamic enhancing pattern (arterial hyperattenuation and late phase washout) between liver metastasis from HAS and HCC was confirmed. Moreover, the presence of isolated portal vein tumor thrombosis and a tendency of tumor necrosis are the imaging clues that suggest the diagnosis of HAS rather than HCC.