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Li QZ, Zhao HB, Ban N, Wang Q, Zhang JJ, Ding SN, Li HH, Zhou ZH. [Gastric adenocarcinoma with enteroblastic differentiation and elevated serum alpha fetoprotein]. Zhonghua Bing Li Xue Za Zhi 2020; 49:886-890. [PMID: 32892552 DOI: 10.3760/cma.j.cn112151-20191210-00791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the proportion and clinicopathological characteristics of gastric adenocarcinoma with enteroblastic differentiation (GAED) in gastric cancers showing an elevated serum alpha fetoprotein(AFP). Methods: A total of 724 resected gastric adenocarcinomas were collected from 2008 to 2018 at the 904 Hospital of Joint Service Support Force, and cases with pre-operative serum AFP>10 μg/L were screened. From the cases with elevated serum AFP, GAED cases were further evaluated based on morphology. Then the clincopathological features and immunohistochemical phenotypes of GAED were reviewed. In addition, the amplification of HER2 gene was detected with fluorescence in situ hybridization(FISH). When overall survival (OS) and progression-free survival (PFS) of GAED were analyzed, 289 cases ordinary gastric adenocarcinoma with normal serum AFP were employed as a control. Results: The percentage of GAED was 44% (11/25) in gastric cancers with elevated serum AFP. GAED was histologically tubular or papillary with clear cytoplasm, and some GAED cases showed cystadenoid structure similar to embryo sac (5 cases), homogeneous eosinophilic granules (4 cases) and intragland ulareosinophilic material (6 cases). All 11 GAED cases had lymph node metastasis. Liver metastasis and vascular thrombus were observed in 2 cases and 5 cases respectively. GAED was immunohistochemically positive for CDX2 (11/11), CD10 (8/11) and MUC2(3/11), which were intestinal epithelium differentiation markers. Meanwhile, primitive markers SALL4 (8/11), GPC3 (7/11) and AFP (5/11) were also expressed in GAED, and HER2 gene amplification was found in 3 cases (3/11) of GAED. Lastly, the PFS of GAED were significantly shorter than that of the control group (P=0.02), while OS was not statistically different between these two groups (P=0.99). Conclusions: Patients with GAED usually have a higher rate of elevated serum AFP in gastric adenocarcinoma, and the cancer exhibites features of both intestinal and primitive differentiation. As GAED is highly invasive, the prognosis of GAED may be poor. For GAED, the diagnosis of well-differentiated or moderately-differentiated adenocarcinoma should be avoided, because this diagnosis leads to underestimated malignant potential.
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Affiliation(s)
- Q Z Li
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
| | - H B Zhao
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
| | - N Ban
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
| | - Q Wang
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
| | - J J Zhang
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
| | - S N Ding
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
| | - H H Li
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
| | - Z H Zhou
- Department of Pathology, the 904 Hospital of Joint Service Support Force, PLA, Jiangsu Province, Wuxi 214044, China
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Abstract
Gastric yolk sac tumors are extremely rare and their prognosis is poor; most patients have widespread metastases at the time of diagnosis. The treatment of gastric yolk sac tumors consists of aggressive chemotherapy combined with radiotherapy and surgery. Here, we first report a case of gastric yolk sac tumor presenting as an early gastric cancer that was cured after a gastrectomy with lymphadenectomy.
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Affiliation(s)
- Yeon Soo Kim
- Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Seok Hyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Koo Seong
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyun Yong Jeong
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyu Sang Song
- Department of Pathology, Chungnam National University College of Medicine, Daejeon, Korea
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