Gastrointestinal Obstruction due to Solitary Lymph Node Recurrence of Alpha-Fetoprotein-Producing Gastric Carcinoma with Enteroblastic Differentiation

Abstract

We report an unusual case of alpha-fetoprotein (AFP)-producing gastric carcinoma with enteroblastic differentiation. A 75-year-old woman was admitted to our hospital with occasional upper abdominal discomfort. We performed gastroscopy and observed a type 2 tumor, primarily in the pyloric region. Histological examination of biopsies confirmed gastric adenocarcinoma. Based on these findings, we diagnosed gastric adenocarcinoma and performed laparoscopic distal gastrectomy with lymph node dissection. Histological examination revealed an invasive lesion composed of adenocarcinoma with a tubulopapillary growth pattern. Tumor cells were cuboidal in shape with characteristically clear cytoplasm rich in glycogen. Two regional lymph node metastases were seen microscopically. Immunohistochemically these cells were positive for AFP, carcinoembryonic antigen, caudal-type homeobox transcription factor 2 and common acute lymphoblastic leukemia antigen. The final diagnosis was AFP-producing gastric carcinoma with enteroblastic differentiation. 26 months after initial surgery, the patient was readmitted to our hospital for gastrointestinal obstruction due to lymph node recurrence.

Early Gastric Cancer with Purely Enteroblastic Differentiation and No Conventional Adenocarcinoma Component

“…The term “GCED” was first used in 1994 by Matsunou et al [ 4 ], although there were prior reports of AFP-producing gastric carcinoma with clear cytoplasm and glandular formation [ 10 , 11 ]. Moreover, there are several published reports identifying GCED in particular, and, currently, AFP-negative cases are included in GCED in case of corresponding morphology and immunohistochemical positivity of other enteroblastic lineage markers (GPC3 or SALL4) [ 1 – 4 , 12 , 13 ]. The histogenesis of GCED has not been clarified, but it has been reported that AFP-producing gastric carcinoma often have mixed histologic types [ 5 , 9 – 12 ].…”

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

“…Motoyama et al[ 21 ] proposed that AFPGCs should be divided into three subtypes: (1) hepatoid type; (2) yolk sac type; and (3) fetal gastrointestinal type. The fetal gastrointestinal type is thought to be equivalent to GCED[ 1 , 3 ]. It is said that most AFPGCs have various mixtures of these histologic types and CGC.…”

“…There are few reports about GCED, and most are case reports. In these earlier reported cases, GCED was histologically characterized as having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm[ 1 - 3 ]. Murakami et al[ 4 ] reported 29 cases of GCED in which stages ranged from an early to an advanced stage based on clinicopathologic and immunohistochemical characteristics.…”