Α-fetoprotein producing hepatoid gastric adenocarcinoma with neuroendocrine differentiation

Abstract

Rationale:Hepatoid gastric adenocarcinoma is a rare type of gastric cancer. The phenomenon of neuroendocrine differentiation (NED) in gastrointestinal tumor needs further research. Both hepatoid adenocarcinoma and neuroendocrine differentiation are the factors leading to a poor prognosis of gastric cancer. However, there is still no specific treatment.Patient Concerns:A 60-year-old man who had a pain and distention in his upper abdomen presented melena. Gastroscopy and pathology revealed a gastric cancer.Diagnoses:Postoperative pathology revealed a hepatoid gastric adenocarcinoma. Immunohistochemical analysis showed a-fetoprotein (AFP), hepatocyte, synaptophysin (Syn), and chromogranin A (CgA) positive, and Ki67 60% positive. A-fetoprotein producing hepatoid gastric adenocarcinoma with NED is diagnosed.Interventions:The patient was treated with an R2 radical gastrectomy, but refused chemotherapy.Outcomes:The AFP level was >2000 ng/mL (0–8.78) half a year after the surgery. There was no obvious abnormality from computed tomography (CT). The patient refused positron emission tomography computed tomography (PET-CT) and left the hospital.Lessons:Hepatoid adenocarcinoma and neuroendocrine differentiation are the factors leading to a poor prognosis of gastric cancer. It relapses easily. Long-term follow-up and regular examinations are necessary to detect relapses.

Alfa-Fetoprotein-Producing Female Primary Urethral Adenocarcinoma with Neuroendocrine Differentiation

“…The ratio of female to male has been reported to be 2:3 and the most common histologic subtype among women is adenocarcinoma [6]. An adenocarcinoma can occur in a variety of tissues and organs, including the lungs, colorectum, and prostate, as well as others, and may occasionally be accompanied by NED [3, 7–9]. Interestingly, it has been reported that this phenomenon occurs only rarely, even in female patients with an adenocarcinoma in the urethral diverticulum [10].…”

“…AFP is a protein normally produced by the liver and yolk sac of a developing fetus, and widely used as a serum biomarker for hepatocellular carcinomas and yolk sac tumors. In addition to those tumors, several types of malignancy, including lung, ovarian, and gastrointestinal cancer, are known to occasionally produce AFP [7–9], though an elevated level in serum is extremely rare in cases of urethral cancer. To date, the mechanisms underlying AFP production by these tumor cells has not been well elucidated.…”

“…To date, the mechanisms underlying AFP production by these tumor cells has not been well elucidated. Interestingly, cancer with NED has been reported to be occasionally accompanied by an elevated serum AFP level, which is thought to be a marker of tumor cell dedifferentiation [7, 9, 14]. In addition, it is important to note that the urethra is embryologically derived from a cloaca containing AFP.…”

Prognostic Analysis of Gastric Signet Ring Cell Carcinoma and Hepatoid Adenocarcinoma of the Stomach: A Propensity Score-Matched Study

“…Hepatoid adenocarcinoma of the stomach (HAS) is a rare type of primary gastric cancer (GC), and most previous studies have reported that the incidence of HAS is less than 1% of all GC ( 1 , 2 ). According to the World Health Organization (WHO) gastrointestinal tumor sample classification, hepatoid adenocarcinoma (HAC) is defined as adenocarcinoma of extrahepatic origin with morphological features of liver cell differentiation, composed of large polygonal eosinophilic hepatocytes such as neoplastic cells ( 3 ). The etiology of HAS is not clear, and some studies suggest that the occurrence of HAS may be related to the common embryonic origin of the stomach and liver from the foregut ( 4 ).…”

Clinicopathological and Prognostic Characteristics of Hepatoid Adenocarcinoma of the Stomach

“…Hepatoid adenocarcinoma (HAC) is a particular type of extrahepatic adenocarcinoma with morphological characteristics similar to hepatocellular carcinoma (HCC) [1].In 1985, Ishikura et al reported a case of AFP-producing primary gastric adenocarcinoma and rst described HAC as a type of tumor that produces large amounts of AFP and has morphological and immunohistochemical characteristics of liver differentiation [2].However, in 1997, he reported a case of primary gastric cancer with histological characteristics similar to hepatocellular carcinoma and negative AFP expanding the scope of HAC to have liver differentiation characteristics regardless of whether AFP is positive [3].Nagai et al also proposed that HAC should be de ned based on histological features similar to hepatocellular carcinoma, regardless of whether the tumor produces AFP [4].The stomach is the most common site of HAC [5]. In addition, HAC can also be found in the gallbladder, uterus, lung, bladder, esophagus, colon, and ovary [1,6].The incidence of hepatoid adenocarcinoma of stomach (HAS) accounts for only 0.17-1% of all gastric cancers [7][8][9][10]. The clinical symptoms are not speci c compared with the common gastric cancer (CGC), but the prognosis of HAS is worse than CGC because of its frequent vascular involvement, and lymph node and liver metastasis [5,11].In this retrospective study, we analyzed the clinical and pathological features of 31 cases of HAS and described the factors affecting prognosis.…”