Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2016; 22(36): 8203-8210
Published online Sep 28, 2016. doi: 10.3748/wjg.v22.i36.8203
Clinicopathological features of alpha-fetoprotein producing early gastric cancer with enteroblastic differentiation
Kohei Matsumoto, Hiroya Ueyama, Kenshi Matsumoto, Yoichi Akazawa, Hiroyuki Komori, Tsutomu Takeda, Takashi Murakami, Daisuke Asaoka, Mariko Hojo, Natsumi Tomita, Akihito Nagahara, Yoshiaki Kajiyama, Takashi Yao, Sumio Watanabe
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 Tomita, Yoshiaki Kajiyama, Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan
Akihito Nagahara, Department of Gastroenterology, Juntendo University Shizuoka Hospital, Shizuoka 410-2295, Japan
Takashi Yao, Department of Pathology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
Author contributions: Matsumoto K and Ueyama H designed and performed the study and wrote the paper; Akazawa Y, Komori H, Takeda T, Murakami T, Asaoka D and Hojo M performed research; Matsumoto Kenshi, Tomita N, Kajiyama Y, Yao T, Nagahara A and Watanabe S critically revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Juntendo University School of Medicine Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by verbal consent. Individuals can’t be identified according to the data presented.
Conflict-of-interest statement: All authors declare that there is no conflict of interest with the paper presented.
Data sharing statement: Informed consent for data sharing was not obtained but the presented data are anonymized and the risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kohei Matsumoto, MD, Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan. khmatsu@juntendo.ac.jp
Telephone: +81-3-58021058 Fax: +81-3-38138862
Received: March 15, 2016
Peer-review started: March 18, 2016
First decision: July 12, 2016
Revised: July 25, 2016
Accepted: August 8, 2016
Article in press: August 8, 2016
Published online: September 28, 2016
Processing time: 194 Days and 15.4 Hours
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.

Keywords: Alpha-fetoprotein-producing gastric cancer; Gastric cancer with enteroblastic differentiation; Early gastric cancer; Glypican 3; SALL4

Core tip: We evaluated the comparison of clinicopathological features between 6 cases of early stage gastric cancer with enteroblastic differentiation (GCED) and 186 cases of early stage conventional gastric cancer (CGC: well/ moderately differentiated adenocarcinoma). Lymphatic, venous, and submucosal invasion rates were higher in GCED than CGC (33.3% vs 2.3%, 66.6% vs 0.4%, 66.6% vs 11.4% respectively, P < 0.01). In addition, Glypican 3 was the most sensitive marker for GCED (positivity, 83.3%), immunohistochemically. GCED has high malignant potential even at an early stage, and preoperative diagnosis is considered difficult. Further investigations are needed to establish optimal treatment approaches for GCED.