Sun L, Wei JJ, An R, Cai HY, Lv Y, Li T, Shen XF, Du JF, Chen G. Gastric adenosquamous carcinoma with an elevated serum level of alpha-fetoprotein: A case report. World J Gastrointest Surg 2023; 15(10): 2357-2361 [PMID: 37969716 DOI: 10.4240/wjgs.v15.i10.2357]
Corresponding Author of This Article
Gang Chen, MD, PhD, Adjunct Professor, Chief Doctor, Department of General Surgery, The 7th Medical Center of PLA General Hospital, No. 5 NanmenCang, Beijing 100700, China. chengang@301hospital.com.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2357-2361 Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2357
Gastric adenosquamous carcinoma with an elevated serum level of alpha-fetoprotein: A case report
Liang Sun, Juan-Juan Wei, Ran An, Hui-Yun Cai, Yuan Lv, Tao Li, Xiao-Fei Shen, Jun-Feng Du, Gang Chen
Liang Sun, Hui-Yun Cai, Yuan Lv, Tao Li, Xiao-Fei Shen, Jun-Feng Du, Gang Chen, Department of General Surgery, The 7th Medical Center of PLA General Hospital, Beijing 100700, China
Juan-Juan Wei, Operating Room, Department of Anesthesiology, The 7th Medical Center of PLA General Hospital, Beijing 100700, China
Ran An, Department of Pathology, The 7th Medical Center of PLA General Hospital, Beijing 100700, China
Author contributions: Sun L and Wei JJ contributed equally to this work, contributed to the conceptualization and writing-original draft; An R, Cai HY, Li T, Lv Y and Shen XF provided technical support for the staining of the sections and performed standard pathologic analysis; Du JF and Chen G involved in the writing-review and editing; the work reported in the article has been performed by the authors, unless clearly specified in the text; and all authors read and approved the final manuscript.
Supported bythe National Natural Science Foundation of China, No. 81970500, 81571563 and 81870393.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised in accordance with it.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Chen, MD, PhD, Adjunct Professor, Chief Doctor, Department of General Surgery, The 7th Medical Center of PLA General Hospital, No. 5 NanmenCang, Beijing 100700, China. chengang@301hospital.com.cn
Received: June 16, 2023 Peer-review started: June 16, 2023 First decision: July 23, 2023 Revised: July 29, 2023 Accepted: August 18, 2023 Article in press: August 18, 2023 Published online: October 27, 2023 Processing time: 133 Days and 6.2 Hours
Abstract
BACKGROUND
Gastric adenosquamous carcinoma (ASC) is rare and characterized by coexisting of adenocarcinoma andsquamous carcinoma within the same tumor. We present a female patient with gastric ASC who had an elevated serum level of alpha-fetoprotein (AFP), which decreased to normal levels after a laparoscopic distant radical gastrectomy in a short period. The clinicopathological features in AFP-producing gastric cancer (GC) are discussed, as well as potentially available prognostic predictors.
CASE SUMMARY
A 50-year-old woman presented to our department with a chief complain of a 6-mo history of bloating. She had no basic diseases including heart diseases and respiratory diseases, and she also denied any prior history of dysphagia, hematemesis, melena, rectal bleeding, hematochezia, or unintentional weight loss. Based on her symptoms, an esophagogastroduodenoscopy was performed, showing an annular cavity lesion 3 cm from the pylorus with a diameter of 6 cm. A biopsy of the lesion showed gastric ASC, whereas the pylorus biopsy showed normal mucosa. The patient further received an enhanced computed tomography scan which demonstrated an invasive lesion close to the pylorus with a still clear margin of the tumor to peripheral organs such as the pancreas and liver. Scattered lymph nodes were visible around, whereas no sign of liver metastasis was discovered. Serum tumor markers including carcinoembryonic antigen (CEA), cancer antigen 199 (CA199), CA724, CA125, and CA242 were all normal, while the level of serum AFP increased to 172 ng/mL. A laparoscopic distant radical gastrectomy was performed after exclusion of surgical contraindications. Postoperative pathology results showed that the tumor displayed an ulcerated ASC phenotype (90% of medium to highly-differentiated squamous cell carcinoma, 10% of poorly differentiated adenocarcinoma. Surprisingly, the serum level of AFP decreased to normal level on post operation day 5. The tumor cells were positive for CK5/6, p63, and CEA, and negative for AFP and Epstein-Barr encoding region.
CONCLUSION
We presented a rare case of gastric ASC with elevated serum AFP level, which may be new subtype of AFP-producing GC. Follow-up detection of serum AFP might be a useful tool to predict patient prognosis.
Core Tip: Most patients diagnosed with gastric cancer (GC) have a pathological phenotype of adenocarcinoma, and gastric adenosquamous carcinoma (ASC) is rare. We presented a rare case of gastric ASC with elevated serum alpha-fetoprotein (AFP) level, which may be new subtype of AFP-producing GC. AFP-GC is an aggressive cancer with high incidence of liver or lymph node metastasis. Follow-up detection of serum AFP might be a useful tool to predict prognosis.
