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Clinicopathological features of alpha-fetoprotein producing early gastric cancer with enteroblastic differentiation

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation (GCED).

Methods: We retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early stage conventional gastric cancer (CGC: well or moderately differentiated adenocarcinoma) who underwent endoscopic submucosal dissection or endoscopic mucosal resection from September 2011 to February 2015 in our hospital. GCED was defined as a tumor having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm and immunohistochemical positivity for either alpha-fetoprotein, Glypican 3 or SALL4. The following were compared between GCED and CGC: age, gender, location and size of tumor, macroscopic type, ulceration, depth of invasion, lymphatic and venous invasion, positive horizontal and vertical margin, curative resection rate.

Results: Six cases (5 males, 1 female; mean age 75.7 years; 6 lesions) of early gastric cancer with a GCED component and 186 cases (139 males, 47 females; mean age 72.7 years; 209 lesions) of early stage CGC were investigated. Mean tumor diameters were similar but rates of submucosal invasion, lymphatic invasion, venous invasion, and non-curative resection were higher in GCED than CGC (66.6% vs 11.4%, 33.3% vs 2.3%, 66.6% vs 0.4%, 83.3% vs 11% respectively, P < 0.01). Deep submucosal invasion was not revealed endoscopically or by preoperative biopsy. Histologically, in GCED the superficial mucosal layer was covered with a CGC component. The GCED component tended to exist in the deeper part of the mucosa to the submucosa by lymphatic and/or venous invasion, without severe stromal reaction. In addition, Glypican 3 was the most sensitive marker for GCED (positivity, 83.3%), immunohistochemically.

Conclusion: Even in the early stage GCED has high malignant potential, and preoperative diagnosis is considered difficult. Endoscopists and pathologists should know the clinicopathological features of this highly malignant type of cancer.

No MeSH data available.


Related in: MedlinePlus

Endoscopic findings (case 1). A: Endoscopic examination with a white light image revealed a 10 mm reddish depressed lesion on the posterior wall in the middle third of the stomach. There were no specific features of deep submucosal invasion; B: Endoscopic examination with narrow band imaging (NBI). A demarcation line was clearly present between a depressed lesion and the surrounding mucosa; C: Magnifying endoscopy with NBI findings. Within the demarcation line, an irregular microvascular pattern (bizarre and tortuous vessel) and an irregular microsurface pattern (curved marginal crypt epithelium) are demonstrated. There were no specific features of GCED. GCED: Gastric cancer with enteroblastic differentiation.
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Figure 1: Endoscopic findings (case 1). A: Endoscopic examination with a white light image revealed a 10 mm reddish depressed lesion on the posterior wall in the middle third of the stomach. There were no specific features of deep submucosal invasion; B: Endoscopic examination with narrow band imaging (NBI). A demarcation line was clearly present between a depressed lesion and the surrounding mucosa; C: Magnifying endoscopy with NBI findings. Within the demarcation line, an irregular microvascular pattern (bizarre and tortuous vessel) and an irregular microsurface pattern (curved marginal crypt epithelium) are demonstrated. There were no specific features of GCED. GCED: Gastric cancer with enteroblastic differentiation.

Mentions: This study included 192 cases (144 males, 48 females; mean age 72.8 ± 7 years; 215 lesions) of early stage GCED and CGC. Among 192 cases, there were 6 GCED cases (5 males, 1 female; mean age 75.7 years; 6 lesions) and 186 CGC cases (139 males, 47 females; mean age 72.7 years; 209 lesions). Table 1 shows the clinicopathological findings of the patients with GCED and Table 2 shows results of the comparison between patients with GCED and CGC. Four cases who were checked for Helicobacter pylori (H. pylori) infection by H. pylori-immunoglobulin G were positive. No significant differences were observed in tumor location (U/M/L = 2/2/2 and 23/91/95 in GCED and CGC, respectively), mean tumor size (15.0 and 15.2 mm in GCED and CGC, respectively), and macroscopic types (flat or depressed type/ elevated type = 4/2 and 92/117 in GCED and CGC, respectively). Endoscopically, we could not find specific features of GCED or anticipate deep submucosal invasion (Figure 1). No lesion was diagnosed as GCED by examination of biopsy specimens. Regarding the depth of tumor invasion, the total submucosal invasion rate was significantly higher in GCED than CGC (66.6% vs 11.4%, P < 0.01). Positive rates for lymphatic and venous invasion were significantly higher in GCED than CGC (33.3% vs 2.3% and 66.6% vs 0.4%, P < 0.01). Therefore, the curative resection rate was significantly lower in GCED than CGC (16.7% vs 89.0%, P < 0.01). Moreover, when comparing only SM invasive cancer, the positive rate for venous invasion was significantly higher in GCED than CGC (100% vs 4.2%, P < 0.01) and the curative resection rate was significantly lower in GCED than CGC (0% vs 50%, P < 0.01). In 2 of the 6 GCED cases, additional surgery was performed (case 3: T1N0M0, stage IA; case 6: T1N1M0, stage IIA). Recurrence or metastasis was not seen in any of the 4 GCED cases that were followed from 28 to 51 mo (median 40 mo).


Clinicopathological features of alpha-fetoprotein producing early gastric cancer with enteroblastic differentiation
Endoscopic findings (case 1). A: Endoscopic examination with a white light image revealed a 10 mm reddish depressed lesion on the posterior wall in the middle third of the stomach. There were no specific features of deep submucosal invasion; B: Endoscopic examination with narrow band imaging (NBI). A demarcation line was clearly present between a depressed lesion and the surrounding mucosa; C: Magnifying endoscopy with NBI findings. Within the demarcation line, an irregular microvascular pattern (bizarre and tortuous vessel) and an irregular microsurface pattern (curved marginal crypt epithelium) are demonstrated. There were no specific features of GCED. GCED: Gastric cancer with enteroblastic differentiation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037089&req=5

Figure 1: Endoscopic findings (case 1). A: Endoscopic examination with a white light image revealed a 10 mm reddish depressed lesion on the posterior wall in the middle third of the stomach. There were no specific features of deep submucosal invasion; B: Endoscopic examination with narrow band imaging (NBI). A demarcation line was clearly present between a depressed lesion and the surrounding mucosa; C: Magnifying endoscopy with NBI findings. Within the demarcation line, an irregular microvascular pattern (bizarre and tortuous vessel) and an irregular microsurface pattern (curved marginal crypt epithelium) are demonstrated. There were no specific features of GCED. GCED: Gastric cancer with enteroblastic differentiation.
Mentions: This study included 192 cases (144 males, 48 females; mean age 72.8 ± 7 years; 215 lesions) of early stage GCED and CGC. Among 192 cases, there were 6 GCED cases (5 males, 1 female; mean age 75.7 years; 6 lesions) and 186 CGC cases (139 males, 47 females; mean age 72.7 years; 209 lesions). Table 1 shows the clinicopathological findings of the patients with GCED and Table 2 shows results of the comparison between patients with GCED and CGC. Four cases who were checked for Helicobacter pylori (H. pylori) infection by H. pylori-immunoglobulin G were positive. No significant differences were observed in tumor location (U/M/L = 2/2/2 and 23/91/95 in GCED and CGC, respectively), mean tumor size (15.0 and 15.2 mm in GCED and CGC, respectively), and macroscopic types (flat or depressed type/ elevated type = 4/2 and 92/117 in GCED and CGC, respectively). Endoscopically, we could not find specific features of GCED or anticipate deep submucosal invasion (Figure 1). No lesion was diagnosed as GCED by examination of biopsy specimens. Regarding the depth of tumor invasion, the total submucosal invasion rate was significantly higher in GCED than CGC (66.6% vs 11.4%, P < 0.01). Positive rates for lymphatic and venous invasion were significantly higher in GCED than CGC (33.3% vs 2.3% and 66.6% vs 0.4%, P < 0.01). Therefore, the curative resection rate was significantly lower in GCED than CGC (16.7% vs 89.0%, P < 0.01). Moreover, when comparing only SM invasive cancer, the positive rate for venous invasion was significantly higher in GCED than CGC (100% vs 4.2%, P < 0.01) and the curative resection rate was significantly lower in GCED than CGC (0% vs 50%, P < 0.01). In 2 of the 6 GCED cases, additional surgery was performed (case 3: T1N0M0, stage IA; case 6: T1N1M0, stage IIA). Recurrence or metastasis was not seen in any of the 4 GCED cases that were followed from 28 to 51 mo (median 40 mo).

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation (GCED).

Methods: We retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early stage conventional gastric cancer (CGC: well or moderately differentiated adenocarcinoma) who underwent endoscopic submucosal dissection or endoscopic mucosal resection from September 2011 to February 2015 in our hospital. GCED was defined as a tumor having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm and immunohistochemical positivity for either alpha-fetoprotein, Glypican 3 or SALL4. The following were compared between GCED and CGC: age, gender, location and size of tumor, macroscopic type, ulceration, depth of invasion, lymphatic and venous invasion, positive horizontal and vertical margin, curative resection rate.

Results: Six cases (5 males, 1 female; mean age 75.7 years; 6 lesions) of early gastric cancer with a GCED component and 186 cases (139 males, 47 females; mean age 72.7 years; 209 lesions) of early stage CGC were investigated. Mean tumor diameters were similar but rates of submucosal invasion, lymphatic invasion, venous invasion, and non-curative resection were higher in GCED than CGC (66.6% vs 11.4%, 33.3% vs 2.3%, 66.6% vs 0.4%, 83.3% vs 11% respectively, P &lt; 0.01). Deep submucosal invasion was not revealed endoscopically or by preoperative biopsy. Histologically, in GCED the superficial mucosal layer was covered with a CGC component. The GCED component tended to exist in the deeper part of the mucosa to the submucosa by lymphatic and/or venous invasion, without severe stromal reaction. In addition, Glypican 3 was the most sensitive marker for GCED (positivity, 83.3%), immunohistochemically.

Conclusion: Even in the early stage GCED has high malignant potential, and preoperative diagnosis is considered difficult. Endoscopists and pathologists should know the clinicopathological features of this highly malignant type of cancer.

No MeSH data available.


Related in: MedlinePlus