Clinicopathological features of alpha-fetoprotein producing early gastric cancer with enteroblastic differentiation

Abstract

AIMTo investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation (GCED).METHODSWe retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early stage conventional gastric cancer (CGC: well or moderately differentiated adenocarcinoma) who underwent endoscopic submucosal dissection or endoscopic mucosal resection from September 2011 to February 2015 in our hospital. GCED was defined as a tumor having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm and immunohistochemical positivity for either alpha-fetoprotein, Glypican 3 or SALL4. The following were compared between GCED and CGC: age, gender, location and size of tumor, macroscopic type, ulceration, depth of invasion, lymphatic and venous invasion, positive horizontal and vertical margin, curative resection rate.RESULTSSix cases (5 males, 1 female; mean age 75.7 years; 6 lesions) of early gastric cancer with a GCED component and 186 cases (139 males, 47 females; mean age 72.7 years; 209 lesions) of early stage CGC were investigated. Mean tumor diameters were similar but rates of submucosal invasion, lymphatic invasion, venous invasion, and non-curative resection were higher in GCED than CGC (66.6% vs 11.4%, 33.3% vs 2.3%, 66.6% vs 0.4%, 83.3% vs 11% respectively, P < 0.01). Deep submucosal invasion was not revealed endoscopically or by preoperative biopsy. Histologically, in GCED the superficial mucosal layer was covered with a CGC component. The GCED component tended to exist in the deeper part of the mucosa to the submucosa by lymphatic and/or venous invasion, without severe stromal reaction. In addition, Glypican 3 was the most sensitive marker for GCED (positivity, 83.3%), immunohistochemically.CONCLUSIONEven in the early stage GCED has high malignant potential, and preoperative diagnosis is considered difficult. Endoscopists and pathologists should know the clinicopathological features of this highly malignant type of cancer.

Yolk Sac tumor differentiation in urothelial carcinoma of the urinary bladder: A case report and differential diagnosis

“…Sarcomatoid and chordoid urothelial carcinoma were excluded after the identification of areas with classical YST pattern and immunohistochemistry results. Carcinoma with enteroblastic differentiation has been reported in several organs (gastrointestinal, lung, etc) [16], while carcinoma with hepatoid differentiation has been mainly reported in gynecologic tumors [17], and in urinary tract tumors already mentioned [4].…”

Esophageal Adenocarcinoma with Enteroblastic Differentiation Arising in Ectopic Gastric Mucosa in the Cervical Esophagus: a Case Report and Literature Review

“…In case of stomach location, the gastric mucosal epithelium was covered with tubular adenocarcinoma, and the deeper part of the mucosal layer and the submucosa were composed of tubular adenocarcinoma and adenocarcinoma with enteroblastic differentiation [24]. Kinjo et al suggested that AFP-producing carcinoma developed from tubular adenocarcinoma and invaded into deeper layers [3].…”

Colorectal adenocarcinoma with enteroblastic differentiation: a clinicopathological study of five cases

“…The majority of adenocarcinoma with enteroblastic differentiation cases have been reported to occur in the stomach . Compared with conventional gastric adenocarcinoma, gastric adenocarcinoma with enteroblastic differentiation shows aggressive behaviour characterised by frequent lymphovascular invasion, lymphatic and liver metastases, and is associated with a poor prognosis …”

“…The majority of adenocarcinoma with enteroblastic differentiation cases have been reported to occur in the stomach. 2,[12][13][14] Compared with conventional gastric adenocarcinoma, gastric adenocarcinoma with enteroblastic differentiation shows aggressive behaviour characterised by frequent lymphovascular invasion, lymphatic and liver metastases, and is associated with a poor prognosis. 2,12 Immunohistochemically, in addition to AFP, oncofetal proteins such as glypican-3 (GPC3) and spalt-like transcription factor 4 4 are reportedly associated with gastric adenocarcinoma with enteroblastic differentiation.…”

“…2,[12][13][14] Compared with conventional gastric adenocarcinoma, gastric adenocarcinoma with enteroblastic differentiation shows aggressive behaviour characterised by frequent lymphovascular invasion, lymphatic and liver metastases, and is associated with a poor prognosis. 2,12 Immunohistochemically, in addition to AFP, oncofetal proteins such as glypican-3 (GPC3) and spalt-like transcription factor 4 4 are reportedly associated with gastric adenocarcinoma with enteroblastic differentiation. 2,13,14 GPC3, a cell-surface heparan sulphate proteoglycan, is present in fetal liver and hepatocellular carcinoma or hepatoblastoma.…”