Alpha-fetoprotein–producing gastric carcinoma with enteroblastic differentiation

Abstract

Background. Alpha‐fetoprotein (AFP) is a useful tumor marker for hepatoma and yolk sac tumor. Recently, elevations of serum AFP were reported in patients with other malignancies, especially gastric cancers. Two distinct tumor morphologies, hepatoid and clear cell, have been correlated with AFP production. Methods. Two patients with AFP‐producing gastric carcinoma were evaluated with immunohistochemical, ultrastructural, and biochemical studies. Results. In Patient 1, the primary and metastatic carcinomas consisted homogeneously of tubulopapillary carcinoma with clear cytoplasm. In Patient 2, the cancer was composed of three different areas: tubulopapillary carcinoma with clear cytoplasm, tumor cartilage, and so‐called hepatoid carcinoma. The morphologic characteristics of tubulopapillary carcinoma with clear cytoplasm were similar to those of the developing gut epithelium at the stage of 2–4 months' gestation. The elution patterns of the serum AFP on lectin‐affinity sepharose column study also suggested a correlation with fetal gut differentiation. Conclusions. AFP‐producing clear cell gastric carcinomas are differentiated into fetal intestine. One patient also had hepatocytic and cartilaginous differentiation, indicative of a blastomatous characteristic of the tumor. These tumors arose in association with intestinal metaplasia.

Esophageal Adenocarcinoma with Enteroblastic Differentiation Arising in Ectopic Gastric Mucosa in the Cervical Esophagus: a Case Report and Literature Review

“…Meanwhile, Kinjo et al classified them, according to the characteristic of tumor, as a common adenocarcinoma type, enteroblastic type, hepatoid type, and yolk sac tumor type [3]. The fetal gastrointestinal type and enteroblastic type were considered to be equivalent to carcinoma with enteroblastic differentiation [15]. However, AFP-producing esophageal carcinoma, including adenocarcinoma with enteroblastic differentiation, has not been categorized by the World Health Organization (WHO) classification.…”

“…Histologically, adenocarcinoma with enteroblastic differentiation has a primitive intestinal-like structure, composed of cuboidal or columnar cells with clear cytoplasm [1,3,15]. In case of stomach location, the gastric mucosal epithelium was covered with tubular adenocarcinoma, and the deeper part of the mucosal layer and the submucosa were composed of tubular adenocarcinoma and adenocarcinoma with enteroblastic differentiation [24].…”

“…Adenocarcinoma with enteroblastic differentiation is a subtype of AFP-producing adenocarcinoma. This type of tumor is rare and reported as a case and a series of cases in the stomach [15,16]. Enteroblastic type of adenocarcinoma was reported as histologically cuboidal or as columnar cells with clear cell cytoplasm combined with tubular adenocarcinoma [3,15,16].…”

Practical Points in Gastric Pathology

“…36 However, gastric cancer with clear cell change is not always associated with AFP-producing GC, with 14.5% (9 of 62) of clear cell GCs showing AFP positivity. 39 Clear cell changes have been reported in 74% (17 of 23) of AFPproducing GCs 40 and in 36% (36 of 101) of glypican-3-expressing GCs.…”

Beş Keçide Gözlenen Enzootik Nazal Adenokarsinomda Klinik, Patolojik, İmmunohistokimyasal ve Elektron Mikroskobik İncelemeler

“…AFP is a major plasma protein produced by the yolk sac and the liver during fetal life. AFP expression in adults is often associated with hepatoma or teratoma 19 . This study showed that, ENA was negative for AFP no indication was observed undifferentiated cell proliferation.…”