Background Hepatoid adenocarcinoma of the stomach (HAS) is a rare and aggressive gastric cancer variant with both glandular and hepatocellular differentiation. The AFP-producing subtype is strongly associated with early liver metastasis and poor prognosis, presenting significant diagnostic challenges due to its resemblance to hepatocellular carcinoma (HCC). Case summary A 68-year-old male presented with progressive dizziness and fatigue. Initial contrast-enhanced abdominal CT revealed a hypervascular gastric antral mass with quantitative enhancement values of 52 ± 3 HU (arterial), 78 ± 5 HU (portal), and 85 ± 4 HU (delayed) in the submucosal layer. Serum AFP was markedly elevated at 918.88 ng/mL. Gastroscopic biopsy confirmed AFP-producing HAS. The patient underwent Billroth II gastrectomy. Four months postoperatively, surveillance CT identified multiple new hypervascular liver metastases, prompting right hepatectomy followed by adjuvant radiochemotherapy. At three-month follow-up, the patient was asymptomatic with normalized tumor markers. Conclusion This case illustrates the utility of quantitative CT enhancement analysis for characterizing the hypervascular phenotype of AFP-producing HAS and proposes a conceptual diagnostic framework to differentiate HAS from HCC. Multidisciplinary collaboration and systematic serum AFP screening in patients with gastric lesions are essential for optimal management of this aggressive malignancy.
Zhong et al. (2026) studied this question.