Gastric adenocarcinoma with enteroblastic differentiation followed endoscopically: A case report
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CASE REPORT
Gastric adenocarcinoma with enteroblastic differentiation followed endoscopically: A case report Tomoya Kimura1 · Takuto Hikichi2 · Jun Nakamura1,2 · Mika Takasumi1 · Minami Hashimoto1,2 · Tsunetaka Kato1,2 · Ryoichiro Kobashi1 · Tadayuki Takagi1 · Rei Suzuki1 · Mitsuru Sugimoto1 · Yuki Sato1 · Hiroki Irie1 · Zenichiro Saze3 · Masao Kobayakawa4 · Koji Kono3 · Hiromasa Ohira1 Received: 8 June 2020 / Accepted: 22 August 2020 © Japanese Society of Gastroenterology 2020
Abstract A 70-year-old man underwent endoscopy, which revealed a slightly depressed and elevated gastric cancer with suspected submucosal invasion of the mid gastric body. Biopsy specimens revealed differentiated tubular adenocarcinoma. We also detected lung and esophageal cancer and prioritized treatment of these lesions, and the patient underwent three endoscopies to monitor changes in gastric cancer. The tumor size and color remained unchanged; however, the marginal ridge was prominent, and the depressed area was deeper on subsequent evaluation. Total gastrectomy was performed 9 months after the first endoscopy. Histopathological examination of the resected specimens showed muscularis propria invasion, well-differentiated tubular adenocarcinoma involving the superficial mucosa, and tumor cells showing clear cytoplasm and a columnar or threedimensional structure, between the deep mucosa and submucosa. The cells were immunopositive for Sal-like protein 4 and glypican 3; therefore, the patient was diagnosed with gastric adenocarcinoma with enteroblastic differentiation (GAED). This rare gastric cancer variant constituted approximately 70% of the entire lesion, and we observed significant lymphovascular invasion and lymph node metastasis. GAED is a rare histopathological subtype of gastric cancer described in recent years. Few cases of this tumor are reported to date; therefore, our study significantly contributes to the literature. Keywords Alpha-fetoprotein-producing gastric cancer · Enteroblastic differentiation · Follow up · Gastric adenocarcinoma with enteroblastic differentiation · Lymphovascular invasion
Introduction According to the 15th edition of the Japanese Classification of Gastric Carcinoma, gastric cancers that were functionally classified as alpha-fetoprotein (AFP)-producing gastric cancer are currently histopathologically classified as gastric * Takuto Hikichi [email protected] 1
Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
2
Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960‑1295, Japan
3
Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
4
Department of Medical Research Center, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
adenocarcinoma with enteroblastic differentiation (GAED) or gastric hepatoid adenocarcinoma (HAC) [1]. Reportedly, GAED accounts for 2.2% of all gastric cancers [2]. GAED is histopa
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