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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.


Immunohistochemical examination of resected specimens (case 1). A: MUC2; B: MUC5AC; C: MUC6; D: CD10; E: AFP; F: Glypican 3; G: SALL 4. The lesion had focal positivity for MUC6, diffuse positivity for CD10, weak positivity for Glypican 3 and negative staining for MUC2, MUC5AC, AFP and SALL4.
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Figure 3: Immunohistochemical examination of resected specimens (case 1). A: MUC2; B: MUC5AC; C: MUC6; D: CD10; E: AFP; F: Glypican 3; G: SALL 4. The lesion had focal positivity for MUC6, diffuse positivity for CD10, weak positivity for Glypican 3 and negative staining for MUC2, MUC5AC, AFP and SALL4.

Mentions: Histological examination of GCED demonstrated the presence of tubulopapillary carcinoma with clear cytoplasm at the deeper part of the mucosa and submucosa by lymphatic and/or venous invasion, and there was no severe stromal reaction. In all GCED cases, the superficial mucosal layer was covered with a conventional tubular adenocarcinoma (Figure 2). All GCED patients were positive for at least one of three enteroblastic lineage markers (AFP, Glypican 3, SALL 4). Glypican 3 was the most sensitive marker (positivity, 83.3%). Four cases were classified as having the gastrointestinal phenotype (4/6; 66.7%), and two as the intestinal type (2/6; 33.3%) according to combinations of the expression of CD10, MUC2, MUC5AC, and MUC6 (Figure 3).


Clinicopathological features of alpha-fetoprotein producing early gastric cancer with enteroblastic differentiation
Immunohistochemical examination of resected specimens (case 1). A: MUC2; B: MUC5AC; C: MUC6; D: CD10; E: AFP; F: Glypican 3; G: SALL 4. The lesion had focal positivity for MUC6, diffuse positivity for CD10, weak positivity for Glypican 3 and negative staining for MUC2, MUC5AC, AFP and SALL4.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Immunohistochemical examination of resected specimens (case 1). A: MUC2; B: MUC5AC; C: MUC6; D: CD10; E: AFP; F: Glypican 3; G: SALL 4. The lesion had focal positivity for MUC6, diffuse positivity for CD10, weak positivity for Glypican 3 and negative staining for MUC2, MUC5AC, AFP and SALL4.
Mentions: Histological examination of GCED demonstrated the presence of tubulopapillary carcinoma with clear cytoplasm at the deeper part of the mucosa and submucosa by lymphatic and/or venous invasion, and there was no severe stromal reaction. In all GCED cases, the superficial mucosal layer was covered with a conventional tubular adenocarcinoma (Figure 2). All GCED patients were positive for at least one of three enteroblastic lineage markers (AFP, Glypican 3, SALL 4). Glypican 3 was the most sensitive marker (positivity, 83.3%). Four cases were classified as having the gastrointestinal phenotype (4/6; 66.7%), and two as the intestinal type (2/6; 33.3%) according to combinations of the expression of CD10, MUC2, MUC5AC, and MUC6 (Figure 3).

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.