Alpha-Fetoprotein-Producing Early Gastric Cancer with Intramucosal Hepatoid and Fetal Enteric Differentiation

Abstract

Alpha-fetoprotein (AFP)-producing gastric carcinomas (AFPGCs) are relatively rare tumors known to have a poor prognosis and commonly found as advanced lesions. Histologically, AFPGCs have been described as having hepatoid and fetal enteric (enteroblastic) morphology and are associated with conventional adenocarcinomas. Prior studies reported a hepatoid component present only in invasive areas and hypothesized that AFPGCs may develop hepatoid features during the process of tumor invasion. We report three cases of AFP-producing early gastric cancer which had an intramucosal hepatoid component. Immunohisto

Pathologically diagnosed early‐stage gastric adenocarcinoma with enteroblastic differentiation after endoscopic submucosal dissection: A case report

“…They are classified by images of hematoxylin and eosin staining and immunostaining, and SALL4 and Glypican3 are known as sensitive markers for the diagnosis of not only AFPGC but also GAED. 4,5 In our case, the microscopic pathological image with hematoxylin and eosin staining revealed tumor cells with pale cytoplasm, and in addition to AFP, the immunostaining of SALL4 and Glypican3 was positive. For endoscopists, pathological specimen confirmation and discussion with a pathologist are important for diagnosing AFP-producing early-stage gastric cancer.…”

“…The typical histological types of AFP‐producing gastric carcinoma are hepatoid adenocarcinoma (HAC), which is considered a rare/other histologic subtype of gastric adenocarcinoma, GAED, yolk sac tumor‐like carcinoma, and common types of adenocarcinoma that do not demonstrate the above histological features. They are classified by images of hematoxylin and eosin staining and immunostaining, and SALL4 and Glypican3 are known as sensitive markers for the diagnosis of not only AFPGC but also GAED 4,5 . In our case, the microscopic pathological image with hematoxylin and eosin staining revealed tumor cells with pale cytoplasm, and in addition to AFP, the immunostaining of SALL4 and Glypican3 was positive.…”

“…AFP-producing early-stage gastric cancer was reported in 47 patients from 1990 to 2022, including our cases (Table 1). [3][4][5][6][7][8][9][10] Additionally, we could not find reports regarding early-stage cases of AFP-producing gastric cancer outside of Japan. The gross type was IIa+IIc/IIc+IIa in 23 cases (49%), and the histological types were por, tub2, and tub1, in that order.…”