Abstract

A 77-year-old man presenting with diarrhea and upper abdominal pain was referred to our hospital owing to multiple liver nodules and bulky gastric lymph node noted on abdominal contrast computed tomography (CT). His serum alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) levels were 187,800 ng/mL and 135,000 mAU/mL, respectively. The liver tumors displayed an enhanced hepatocellular pattern on the contrast CT scan; however, there was no hepatitis viral infection or chronic liver cirrhosis. On contrast magnetic resonance imaging, the liver nodules showed high intensity on the T2-weighted image, and the differential diagnosis by CT was liver metastasis. Upper gastrointestinal endoscopy revealed an advanced gastric carcinoma (type 2) in the cardia, which was histopathologically diagnosed as gastric adenocarcinoma. The tumor cell expressed AFP, and histopathological findings of the liver tumor due to core needle biopsy were similar to those of the gastric lesion; however, the liver tumor was positive for AFP and DCP. Thus, the tumor was clinically diagnosed as a gastric carcinoma producing both AFP and DCP.