Gastric cancer in the pediatric population, a multicenter cross-sectional analysis of presentation and coexisting comorbidities

Adolescents and young adults with germline CDH1 variants and the risk of overtreatment

BACKGROUND

Adolescents and young adults (AYA) with germline CDH1 variants are at risk of overtreatment when precancer lesions are detected with endoscopic screening. We characterize diffuse-type gastric cancer prevalence and survival in AYA managed with prophylactic total gastrectomy (PTG) or endoscopic surveillance.

METHODS

Prospective cohort study of 188 individuals aged 39 and younger enrolled from January 27, 2017, to May 1, 2023. Clinicopathological data, prevalence of early gastric signet ring cell (SRC) lesions, advanced gastric cancer diagnoses, and cancer-specific survival were measured.

RESULTS

Among 188 AYA patients, 104 chose surveillance and 67 pursued PTG for management of elevated gastric cancer risk. AYA who enrolled early in the study period and had SRC lesions detected on preoperative endoscopy were more likely to elect for PTG compared with surveillance. SRC lesions were detected on preoperative endoscopy in 48% of patients who subsequently had PTG, and yet nearly all (93%, 62/67) had multifocal SRC (pT1aN0) on final pathology. Median age at enrollment (30 vs 31 years, P = .21), biological sex (P = .17), and median number of family members with gastric cancer (3 vs 4, P = .14) were not different between groups. No patients under surveillance developed advanced cancer or developed cancer recurrence after PTG with a median follow-up of 2.5 years (IQR = 1.6-4.0) from initial endoscopy.

CONCLUSIONS

Cancer-specific outcomes were not different in AYA who harbored SRC and were managed with surveillance or PTG. Lack of cancer-specific deaths and low prevalence of advanced gastric cancer underscore the risk of overtreatment of SRC lesions and suggest that active surveillance is warranted.

A case of neonatal gastric teratoma complicated with occult gastrointestinal hemorrhage misdiagnosed as lymphangioma

BACKGROUND

Gastric teratoma is a rare neoplasm, particularly in neonates, and usually presents as a palpable abdominal mass. However, severe occult gastrointestinal bleeding is uncommon and often misdiagnosed. Imaging studies are crucial for the preoperative diagnosis of neonatal teratoma, but definitive diagnosis relies on pathological examination.

CASE PRESENTATION

A 28-day-old boy presented with abdominal distension accompanied by vomiting for 2 days without hematemesis or melena. A complete blood count upon admission showed a hemoglobin level of 37 g/L. Ultrasound and computed tomography scans indicated a large cystic, solid mass in the abdominal cavity (approximately 9.8 × 8.8 × 11.2 cm), containing nodules, septa, calcification, and fat, and causing gastrointestinal compression. The mass was misdiagnosed as lymphangioma with hemorrhage before surgery. During surgery, the upper pole of the tumor was found to be fused with the gastric wall of the greater curvature of the fundus of the stomach, with most of the tumor growing exophytically and a small portion growing into the gastric lumen. The tumor, along with part of the gastric wall at the attachment site, was completely removed. Postoperative pathological examination revealed an immature teratoma grade 1. After discharge, the patient's growth and development were normal, with no adverse manifestations.

CONCLUSIONS

Neonatal gastric teratoma with severe occult gastrointestinal bleeding is extremely rare and hence must be on the list of differential diagnoses of neonatal abdominal mass when a cystic solid mass is found, especially when accompanied by severe anemia without obvious gastrointestinal bleeding. Attention should be paid to the location of the lesion, which is predominantly in the left upper abdomen and has been significantly pushed and displaced by the gastrointestinal tract, and to the imaging characteristics of teratoma such as fat and calcification, which help to exclude other palpable masses encountered during the neonatal period.

Case report: Gastric langerhans cell histiocytosis with BRAF deletion mutation in a child that was misdiagnosed as lymphoma

Langerhans cell histiocytosis (LCH) is a myeloid neoplasm associated with the infiltration of most organs but rarely involves the stomach. Stomach tumors in children are very rare and can be easily misdiagnosed. We report the first case of gastric LCH in a 9-year-old boy who was misdiagnosed with gastric lymphoma. The patient presented to our outpatient department with recurrent abdominal pain that had lasted 1 month. Due to the absence of typical clinical features associated with lymphoma in the boy, the initial diagnosis of lymphoma based on the first gastric pathological biopsy was questioned. The second pathological examination revealed that the tumor cells expressed CD1a, S-100, and Langerin with BRAF (c.1457_1471del) deletion mutations. The patient's condition rapidly improved after chemotherapy with prednisone and vincristine. This case report focuses on the possibility of gastric LCH in school-aged children and the differential diagnosis of gastric tumors in children.

The Most Recent Insights into the Roots of Gastric Cancer

Helicobacter pylori (H. pylori) is the most common bacterial infection worldwide, usually being acquired during childhood, and its persistence into adulthood represents one of the main contributors of gastric carcinogenesis. Based on these statements, it would be of great importance to know if the most early premalignant transformation occurs in children or later since, this would enable the development of effective anti-tumorigenesis strategies. The interplay between H. pylori virulence factors, the host's responses modified by this infection, and the gastric microecology are complex and eventually lead to the development of gastric cancer in susceptible individuals. Several biomarkers were identified as major contributors of this long-lasting process, such as pepsinogens, gastrin 17, lipid-, glucose- and iron-metabolism parameters, immunity players, aberrant bacterial DNA methylation, H. pylori virulence factors, and hallmarks of gastric dysbiosis. Several of these biomarkers were also identified in children with H. pylori infection, independently of the presence of premalignant lesions, which were also proven to be present in a subgroup of H. pylori-infected children, especially those carrying extremely virulent strains. Therefore, the most incipient premalignant gastric changes might indeed occur early during childhood, opening a promising research gate for further studies to delineate the border between infection and cancer.