Tariq Z, Faisal A, Basit A, Iftikhar A, Basil AM. Diagnostic dilemmas in hepatoid adenocarcinoma of the stomach: Navigating clinical and pathological loopholes. World J Methodol 2026; 16(1): 110272 [DOI: 10.5662/wjm.v16.i1.110272]
Corresponding Author of This Article
Abdul M Basil, MD, Department of Medicine, Spinghar Medical University, 4th Alley, Char Rahe Qambar Kabul, Kabul 1001, Kābul, Afghanistan. abdulmaboodbasil@outlook.com
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Gastroenterology & Hepatology
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Minireviews
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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/
Mar 20, 2026 (publication date) through Feb 10, 2026
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World Journal of Methodology
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2222-0682
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Tariq Z, Faisal A, Basit A, Iftikhar A, Basil AM. Diagnostic dilemmas in hepatoid adenocarcinoma of the stomach: Navigating clinical and pathological loopholes. World J Methodol 2026; 16(1): 110272 [DOI: 10.5662/wjm.v16.i1.110272]
World J Methodol. Mar 20, 2026; 16(1): 110272 Published online Mar 20, 2026. doi: 10.5662/wjm.v16.i1.110272
Diagnostic dilemmas in hepatoid adenocarcinoma of the stomach: Navigating clinical and pathological loopholes
Zain Tariq, Affan Faisal, Abdul Basit, Abdullah Iftikhar, Abdul M Basil
Zain Tariq, Affan Faisal, Abdul Basit, Abdullah Iftikhar, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Abdul M Basil, Department of Medicine, Spinghar Medical University, Kabul 1001, Kābul, Afghanistan
Author contributions: Tariq Z contributed to the study conception and supervision; Faisal A, Basit A, Iftikhar A, and Basil AM contributed to the writing, citation management, and proofreading.
Conflict-of-interest statement: There are no conflicts of interest of any kind among the authors.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdul M Basil, MD, Department of Medicine, Spinghar Medical University, 4th Alley, Char Rahe Qambar Kabul, Kabul 1001, Kābul, Afghanistan. abdulmaboodbasil@outlook.com
Received: June 3, 2025 Revised: July 12, 2025 Accepted: September 10, 2025 Published online: March 20, 2026 Processing time: 252 Days and 15.9 Hours
Abstract
Hepatoid adenocarcinoma of the stomach (HAS) is a rare and highly aggressive gastric cancer subtype characterized by hepatic morphological features and often elevated alpha-fetoprotein (AFP) levels. Despite its distinct biology HAS frequently eludes early diagnosis due to nonspecific gastrointestinal symptoms, radiological mimicry of hepatocellular carcinoma, and variable expression of diagnostic biomarkers. Imaging modalities like CT and magnetic resonance imaging offer limited specificity, often misinterpreting hepatic metastases as primary liver tumors. While elevated AFP is a supportive clue, it lacks sensitivity and specificity, particularly in AFP-negative HAS. Histologically, HAS poses challenges with subtle or focal hepatoid differentiation, especially in limited biopsy samples. Immunohistochemical variability, especially inconsistent staining of markers like SALL4, Glypican-3, and HepPar-1, further complicates accurate classification. Misdiagnosis can lead to inappropriate management and a worse prognosis. The lack of standardized diagnostic criteria globally exacerbates variability in reporting and treatment decisions. This review outlined the multidimensional diagnostic hurdles in HAS and underscored the necessity of an integrated, multidisciplinary approach. Enhanced tissue sampling, combined immunohistochemical panels, and emerging molecular tools may collectively improve diagnostic accuracy and clinical outcomes for this aggressive gastric malignancy.
Core Tip: Hepatoid adenocarcinoma of the stomach is a rare but aggressive tumor that mimics hepatocellular carcinoma both morphologically and serologically. Diagnostic delays occur due to nonspecific symptoms, radiological ambiguities, and variable biomarker profiles. A multidisciplinary and standardized diagnostic approach is critical for improving early detection and clinical outcomes.
