Primary Gastric Choriocarcinoma (PGC) combined with intestinal fibroblast differentiation-type Alpha-fetoprotein Producing Gastric Cancer (AFPGC) and liver metastasis: a case report

Primary gastric choriocarcinoma (PGC) and alpha-fetoprotein producing gastric cancer (AFPGC) are rare malignancies with no established treatment guidelines and a dismal prognosis. A 69-year-old man presented to the gastroenterology department with epigastric discomfort. The preoperative diagnosis was gastric cancer and a possible hepatic hemangioma. Based on postoperative pathology, immunohistochemistry, and the abnormally elevated <i>β</i>-human chorionic gonadotropin (<i>β</i>-HCG) levels, the diagnosis was revised to PGC combined with intestinal fibroblast differentiation AFPGC with liver metastasis. Given the lack of evidence of immune and targeted therapies as shown by the genetic testing results, postoperatively, the patient was referred to our department for chemotherapy (albumin paclitaxel, oxaliplatin combined with capecitabine), and has survived for over 2 years. Currently, the patient exhibits normal tumor markers and imaging confirms complete remission (CR) with no signs of recurrence. For such rare cases of primary cancer with distant metastasis, cytoreductive surgery before chemotherapy may be one of the optimal options.