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


CONCLUSIONS
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.
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Kohei
K
Matsumoto
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Hiroya
H
Ueyama
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Kenshi
K
Matsumoto
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Yoichi
Y
Akazawa
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Hiroyuki
H
Komori
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Tsutomu
T
Takeda
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Takashi
T
Murakami
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Daisuke
D
Asaoka
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Mariko
M
Hojo
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Natsumi
N
Tomita
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Akihito
A
Nagahara
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Yoshiaki
Y
Kajiyama
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Takashi
T
Yao
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Sumio Watanabe, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Sumio
S
Watanabe
D000230:Adenocarcinoma / Q000378:metabolism* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002454:Cell Differentiation; D003593:Cytoplasm / Q000378:metabolism; D020895:Enterocytes / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000378:metabolism* / Q000473:pathology; D000509:alpha-Fetoproteins / Q000378:metabolism*
D000509:alpha-Fetoproteins
Alpha-fetoprotein-producing gastric cancer; Early gastric cancer; Gastric cancer with enteroblastic differentiation; Glypican 3; SALL4
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