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Shimizu H, Kochi M, Fujii M, Watabe M, Matsuno Y, Kawai T, Suda H, Tanino T, Nakanishi Y, Masuda S, Okamura Y. Human epidermal growth factor 2 overexpressed alpha-fetoprotein-producing-gastric cancer. Discov Oncol 2023; 14:111. [PMID: 37354221 DOI: 10.1007/s12672-023-00731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE This study aimed to elucidate the clinicopathological characteristics of α-fetoprotein (AFP)-producing gastric carcinoma (AFP-GC) with human epidermal growth factor receptor (HER)2 overexpression to extend the treatment strategy for AFP-GC. METHODS We analyzed 41 patients with AFP-GC who underwent surgical resection or chemotherapy from 1989 to 2019, and who had over 20ng/mL of serum AFP or positive immunohistochemical AFP expression. HER2 expression status was investigated by immunohistochemistry (IHC) for all patients and by fluorescence in situ hybridization (FISH) for cases with an IHC score of 2+. AFP-GC with an IHC score of 3 + or 2 + and FISH positivity was defined as HER2 overexpressed AFP-GC. The correlation between HER2 status and clinicopathological characteristics and prognosis in AFP-GC was analyzed. RESULTS HER2 overexpression was detected in 17.1% of AFP-GC patients. The prognosis of the patients with HER2 overexpressed AFP-GC was not significantly different compared to HER2 non-overexpressed AFP-GC. HER2 overexpressed AFP-GC consisted of heterogeneous histology with a higher proportion of mixed-type tumors (p = 0.002). The clinical outcome of AFP-GC with mixed-type of histology tended to be better than other intestinal or diffuse types (p = 0.05). CONCLUSION HER2 overexpressed AFP-GC consisted of a mixed type of histology, which showed a better prognosis. The results presented that HER2 status in AFP-GC is one of the molecular candidates to improve the prognosis.
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Affiliation(s)
- Hiroko Shimizu
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsugu Kochi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Fujii
- Japan Clinical Cancer Research Organization, Tokyo, Japan
| | - Megumu Watabe
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yoritaka Matsuno
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takaharu Kawai
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Suda
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tomoyuki Tanino
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoko Nakanishi
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan.
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Shinobu Masuda
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yukiyasu Okamura
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
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Metachronous Liver Metastasis from Alpha-Fetoprotein-Producing Gastric Cancer Successfully Treated with Capecitabine/Oxaliplatin Combination Chemotherapy. Case Rep Surg 2022; 2022:2700394. [PMID: 36051651 PMCID: PMC9427307 DOI: 10.1155/2022/2700394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
A consensus regarding the treatment of recurrent alpha-fetoprotein-producing gastric carcinoma due to its rarity is lacking. We herein describe a case of such a carcinoma that was associated with metachronous liver metastasis. A 73-year-old man was referred for the surgical treatment of a type 2 gastric tumor that extended from the greater curvature of the gastric corpus to the pylorus. As no remote metastases were detected, the patient underwent open total gastrectomy with lymphadenectomy and Roux-en-Y reconstruction. Histopathological examination revealed regional lymph node metastasis and the invasion of the muscularis propria by a moderately differentiated adenocarcinoma. Immunostaining of the primary tumor was positive for alpha-fetoprotein and negative for human epidermal growth factor receptor 2. Serum alpha-fetoprotein levels decreased to within normal limits after eight courses of S-1 monotherapy; however, levels started to increase, and a hypovascular nodule in segment 5/6 of the liver was detected 3.5 years later. Serum alpha-fetoprotein levels returned to the normal range, and the tumor was undetectable after four courses of capecitabine and oxaliplatin therapy. No recurrence was detected at 1.5-year follow-up. This case demonstrates that combined capecitabine and oxaliplatin therapy can successfully treat metachronous liver metastasis from alpha-fetoprotein-producing gastric carcinoma.
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Wang B, Xie Y, Zheng L, Zheng X, Gao J, Liu X, Yuan Y, Li Z, Lu N, Xue L. Both the serum AFP test and AFP/GPC3/SALL4 immunohistochemistry are beneficial for predicting the prognosis of gastric adenocarcinoma. BMC Gastroenterol 2021; 21:408. [PMID: 34706681 PMCID: PMC8555135 DOI: 10.1186/s12876-021-01986-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both gastric adenocarcinoma with primitive enterocyte phenotype (GAPEP) (including hepatoid adenocarcinoma) and alpha-fetoprotein (AFP)-producing gastric adenocarcinoma have poor prognoses. However, the value of the serum AFP test and AFP/glypican-3 (GPC3)/spalt-like transcription factor 4 (SALL4) immunohistochemistry is still not clear, and these two methods have not yet been thoroughly compared. METHODS We collected 421 consecutive non-neoadjuvant surgically or endoscopically resected gastric adenocarcinoma patients with serum AFP results before surgery (group A). We divided these cases into serum AFP-high (sAFP-H) and serum AFP-normal (sAFP-N) by serum AFP levels, and into GAPEP (expressing AFP, GPC3, or SALL4) and non-GAPEP (nGAPEP) by AFP/GPC3/SALL4 immunohistochemistry results. We also collected 12 non-resected gastric adenocarcinoma patients with serum AFP ≥ 7 ng/mL before treatment (group B). We analyzed these patients' clinicopathological characteristics and prognoses. RESULTS Seventeen (4.04%) patients in group A were sAFP-H. These patients were younger and mainly had tubular adenocarcinoma with later pT (P = 0.014) and pN (P = 0.047) categories and more lymphovascular invasion (P < 0.001), perineural spread (P = 0.008), and metastases or recurrence (P < 0.001). For immunohistochemistry, 34 (8.08%) cases were GAPEP, and GAPEP cases also had later pT categories than nGAPEP cases (P = 0.001). Most group B patients with elevated serum AFP (especially > 1000 ng/mL) had simultaneous metastases, mainly liver metastases. Both the serological method and immunohistochemical method were useful for predicting prognosis (AUC sAFP = 0.625, AUC A/G/S-IHC = 0.723, z statistic = 1.726, P = 0.084). The serum AFP level (especially > 1000 ng/mL) is more specific (100%), and immunohistochemistry is more sensitive (50%). CONCLUSION Both the serum AFP level and immunohistochemical expression of AFP/GPC3/SALL4 can be used to indicate a poor prognosis for gastric adenocarcinoma.
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Affiliation(s)
- Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yibin Xie
- Department of Abdominal Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Li Zheng
- Department of General Surgery, the First People's Hospital of Dongcheng District, Beijing, 100075, China
| | - Xiaohao Zheng
- Department of Abdominal Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jia Gao
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiuyun Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yanling Yuan
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhuo Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Lu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Zhou K, Wang A, Ao S, Chen J, Ji K, He Q, Ji X, Wu X, Zhang J, Li Z, Bu Z, Ji J. The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis. BMC Cancer 2020; 20:671. [PMID: 32680468 PMCID: PMC7368673 DOI: 10.1186/s12885-020-07031-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach (HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery. METHODS We retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. The relationships between gastric cancer type and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression. RESULTS Our data demonstrate that there was no statistically significant difference in the OS between HAS and non-HAS {K-M, P = log rank (Mantel-Cox), (before PSM P = 0.397); (1:1 PSM P = 0.345); (1:2 PSM P = 0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching). CONCLUSION HAS was generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.
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Affiliation(s)
- Kai Zhou
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Anqiang Wang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Sheng Ao
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036 Guangdong China
| | - Jiahui Chen
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Ke Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Qifei He
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Xin Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Xiaojiang Wu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Ji Zhang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Zhongwu Li
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, 100142 China
| | - Zhaode Bu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142 China
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Chen F, Zhang F, Liu Y, Cai C. Simply and sensitively simultaneous detection hepatocellular carcinoma markers AFP and miRNA-122 by a label-free resonance light scattering sensor. Talanta 2018; 186:473-480. [PMID: 29784390 DOI: 10.1016/j.talanta.2018.04.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 04/09/2018] [Accepted: 04/20/2018] [Indexed: 12/21/2022]
Abstract
In this study, an intelligent and label-free sensor is utilized for the first time to one-spot simultaneous detection hepatocellular carcinoma markers AFP and miRNA-122 by a resonance light scattering (RLS) sensor. cDNA1 hybridizes with cDNA2 to form double-stranded DNA (dsDNA). The construction of dsDNA and methyl violet is used to form the RLS sensor via the electronic interaction. When AFP or miRNA-122 is present, the cDNA (cDNA1 or cDNA2) can bindings of target, thereby RLS intensity changed proportionally with the concentration of AFP or that of miRNA-122. The detection limits of AFP and miRNA-122 are 0.94 μg/L and 98 pM respectively, and their good linear which ranges from 5 to 100 μg/L and 200 pM to 10 nM are achieved using the assay. In the presence of miRNA-122 and AFP mixtures, AFP bound to the AFP aptamer to increase the RLS signal, and miRNA-122 bound to the miRNA-122 complementary strand to decrease the RLS signal. The RLS signal changed in response to changing AFP and miRNA-122 concentrations, so that one-spot simultaneous detection of alpha fetal protein and miRNA-122 is achieved. This method has potential practical applications in the research of hepatocellular carcinoma.
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Affiliation(s)
- Feng Chen
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Application of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan 411105, China
| | - Feng Zhang
- College of Science, Hunan Agricultural University, Changsha 410128, China
| | - Yi Liu
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Application of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan 411105, China
| | - Changqun Cai
- Key Laboratory for Green Organic Synthesis and Application of Hunan Province, Key Laboratory of Environmentally Friendly Chemistry and Application of Ministry of Education, College of Chemistry, Xiangtan University, Xiangtan 411105, China.
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He R, Yang Q, Dong X, Wang Y, Zhang W, Shen L, Zhang Z. Clinicopathologic and prognostic characteristics of alpha-fetoprotein-producing gastric cancer. Oncotarget 2017; 8:23817-23830. [PMID: 28423604 PMCID: PMC5410346 DOI: 10.18632/oncotarget.15909] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/07/2017] [Indexed: 12/18/2022] Open
Abstract
Alpha-fetoprotein–producing gastric cancer (AFPGC) accounts for 1.5%–7.1% of all gastric cancer cases. Compared with other types of gastric cancer, AFPGC is more aggressive and prone to liver and lymph node (LN) metastasis, with extremely poor prognosis. To improve understanding of AFPGC we reviewed a consecutive series of 82 AFPGC patients and investigated the prognostic factors. The incidence of AFPGC among our gastric cancer patients was 1.95%, and 29.27% of AFPGCs were diagnosed with metastasis at the time of presentation, mainly liver metastasis. The serum AFP level of patients with AFPGC was significantly associated with tumor differentiation. Histologically, these AFPGC patients were composed of 34.55% hapatiod type, 58.18% fetal gastrointestinal type, 9.09% yolk sac tumor-like type, and 14.55% mixed type. Patient gender, tumor differentiation, Lauren classification, and number of metastatic lymph nodes showed significant differences among these four subtypes. The overall survival time was 42.02 months and the 3-year cumulative survival rate was 53.13%. Age, American Joint Committee on Cancer (AJCC) TNM staging classification (TNM stage), serum AFP level, and surgery were prognostic factors for overall survival; however, TNM stage was the only independent risk factor for prognosis of AFPGC. In short, AFPGC is a rare, unique, and heterogeneous entity, and its proper identification and treatment remain a challenge. More attention should be paid to AFPGC to improve patient care and the dismal prognosis.
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Affiliation(s)
- Ruji He
- Division of Gastrointestinal Surgery, Department of General Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Qinyi Yang
- Department of Pathology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xuqiang Dong
- Division of Gastrointestinal Surgery, Department of General Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yao Wang
- Division of Gastrointestinal Surgery, Department of General Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Weiming Zhang
- Department of Pathology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Lizong Shen
- Division of Gastrointestinal Surgery, Department of General Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Zhihong Zhang
- Department of Pathology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
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Chang MY, Kim HJ, Park SH, Kim H, Choi DK, Lim JS, Park MS, Kim MJ, Kim H. CT features of hepatic metastases from hepatoid adenocarcinoma. Abdom Radiol (NY) 2017; 42:2402-2409. [PMID: 28421242 DOI: 10.1007/s00261-017-1150-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to report the imaging presentation of hepatic metastases from hepatoid adenocarcinoma (HAC). METHODS We retrospectively identified 11 patients (10 men and 1 woman; median age 66) with HAC liver metastasis who underwent contrast-enhanced computed tomography (CT) which included arterial phase and portal venous phase. Two radiologists analyzed the imaging parameters, which included the enhancement pattern on arterial and portal phase images, necrosis, venous thrombi, and overall imaging diagnosis, and arrived at a consensus. RESULTS On arterial phase, the liver lesions had global hyper-enhancement (n = 0), heterogeneous hyper-enhancement (63.6%; n = 7/11), peripheral hyper-enhancement (n = 0), iso-enhancement (n = 0/11), or hypo-enhancement (36.4%; n = 4/11). On portal venous phase, homogenous hypo-enhancement (18.2%; n = 2/11) and heterogenous hypo-enhancement (81.8%; n = 9/11) were observed. Venous thromboses occurred in four patients (36.4%; n = 4/11). The overall imaging diagnoses were "HCC-like" in seven patients (63.6%; n = 7/11), "indeterminable" in 1 patient (9.1%; n = 1/11), and "HCC-unlike" in three patients (27.3%; n = 3/11). CONCLUSIONS The imaging features of HAC liver metastasis were varied. Arterial phase enhancement coupled with venous phase washout (resembling HCC imaging features) was a major finding, but arterial phase hypo-enhancement (distinct from HCC imaging features) was also frequently encountered.
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Saitta C, Raffa G, Alibrandi A, Brancatelli S, Lombardo D, Tripodi G, Raimondo G, Pollicino T. PIVKA-II is a useful tool for diagnostic characterization of ultrasound-detected liver nodules in cirrhotic patients. Medicine (Baltimore) 2017; 96:e7266. [PMID: 28658121 PMCID: PMC5500043 DOI: 10.1097/md.0000000000007266] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Protein induced by vitamin K absence-II (PIVKA-II) is a potential screening marker for hepatocellular carcinoma (HCC). Limited data are available about its utility in discriminating neoplastic from regenerative nodules at ultrasonography (US) evaluation in cirrhotic patients. Aim of this study was to investigate the diagnostic utility of PIVKA-II in cases showing liver nodules of uncertain diagnosis at US.Ninety cirrhotics with US evidence of liver nodule(s) were enrolled. All patients underwent blood sampling within 1 week of US and were thereafter followed up. HCC was confirmed in 40/90 cases, and in all cases it was in a very early/early stage. All sera were tested for PIVKA-II and alpha-fetoprotein (AFP) at the end of follow-up. PIVKA-II at a cut off of 60 mAU/mL was significantly associated with HCC at both univariate and multivariate analysis (P = .016 and P = .032, respectively). AFP at a cut off of 6.5 ng/mL was not associated with HCC at univariate analysis (P = .246). ROC curves showed that PIVKA-II had 60% sensitivity, 88% specificity, 80% positive predictive value (PPV), and 73% negative predictive value (NPV), whereas AFP had 67% sensitivity, 68% specificity, 63% PPV, and 72% NPV. AUROC curves showed that the combination of both biomarkers increased the diagnostic accuracy for HCC (AUC 0.76; sensitivity 70%, specificity 94%, PPV 91%, and NPV 79%).In conclusion, PIVKA-II is a useful tool for the diagnostic definition of US-detected liver nodules in cirrhotic patients, and it provides high diagnostic accuracy for HCC when combined with AFP.
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Affiliation(s)
- Carlo Saitta
- Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina
| | - Giuseppina Raffa
- Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina
- Department of Clinical and Experimental Medicine
| | | | - Santa Brancatelli
- Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina
- Department of Clinical and Experimental Medicine
| | | | | | - Giovanni Raimondo
- Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina
- Department of Clinical and Experimental Medicine
| | - Teresa Pollicino
- Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina
- Department of Human Pathology, University of Messina, Messina, Italy
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Nuevo-Gonzalez JA, Cano-Ballesteros JC, Lopez B, Andueza-Lillo JA, Audibert L. Alpha-Fetoprotein-Producing Extrahepatic Tumor: Clinical and Histopathological Significance of a Case. J Gastrointest Cancer 2016; 43 Suppl 1:S28-31. [PMID: 21826411 DOI: 10.1007/s12029-011-9310-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The serum rise of alpha-fetoprotein (AFP) has been relationed to hepatic tumors. Other than these, such as gastric adenocarcinoma, can present with high levels of this glycoprotein. One rare kind of gastric adenocarcinoma, called hepatoid subtype, has two essential features: hepatoid differentiation in histology and high levels of AFP in serum. DISCUSSIONS We report a Spanish female who consulted because of fatigue, anorexia, and weight loss. In laboratory data, she presented anemia and markedly elevation of AFP. On CT scan, a gastric mass resulted without hepatic dissemination, and subsequently, gastroduodenoscopy was performed for histological diagnosis. Then, an ulcerated mass was detected and sample was taken, resulting in poorly-differentiated adenocarcinoma of stomach with hepatoid tissue foci, with intense positivity for AFP-immunohistochemical staining. This rare cancer has poor prognosis even with early gastrectomy and chemotherapy.
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Affiliation(s)
- Jose A Nuevo-Gonzalez
- Emergency Department, Rapid diagnosis Unit, Madrid, Spain. .,Emergency department, Hospital Gregorio Marañón, C/Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | | | - Beatriz Lopez
- Department of Pathology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Luis Audibert
- Department of Internal Medicine, Hospital Gregorio Marañón, Madrid, Spain
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Regional Arterial Infusion Chemotherapy improves the Pathological Response rate for advanced gastric cancer with Short-term Neoadjuvant Chemotherapy. Sci Rep 2015; 5:17516. [PMID: 26620627 PMCID: PMC4664910 DOI: 10.1038/srep17516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/30/2015] [Indexed: 12/29/2022] Open
Abstract
To identify clinicopathologic and treatment variables that could predict pathologic tumor response to short-term neoadjuvant chemotherapy (NAC) for patients with locally advanced gastric cancer. A retrospective analysis was conducted of 178 patients who underwent short-term NAC with EOX regimen followed by surgery from January 2008 to December 2010. Neoadjuvant treatment response was evaluated using tumor regression grade. Relationships between pathologic tumor response and clinicopathological factors were evaluated using logistic regression analysis. The benefits of regional arterial infusion chemotherapy were investigated separately. The postoperative pathological response rate was 46.1% (82/178) and 4 patients (2.2%) had complete pathological remission. Pathological response was significantly associated with tumor differentiation (P = 0.008), abnormal a-fetoprotein levels (P = 0.01) and administration approach to chemotherapy (intravenous versus regional arterial infusion chemotherapy) (P = 0.018). Most bone marrow toxicities, vomiting, nausea, alopecia, and fatigue were acceptable. Grade 3/4 toxicities were not commonly observed. The 3-year overall survival (OS) and recurrence free survival (RFS) were 67.0% and 53.0%, respectively. Regional arterial infusion NAC group had significantly better median RFS (48.0 versus 34.0 months) than the intravenous NAC group (P = 0.049). In conclusion, regional arterial infusion NAC can improve the pathological response rate of advanced gastric cancer treated with EOX regimen.
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Alpha Fetoprotein-Secreting Gastric Cancer in the Setting of Chronic Hepatitis B: The Role of Endoscopy. ACG Case Rep J 2015; 2:152-4. [PMID: 26157947 PMCID: PMC4435407 DOI: 10.14309/crj.2015.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/17/2015] [Indexed: 11/17/2022] Open
Abstract
Alpha-fetoprotein (AFP) is a common tumor marker for hepatocellular carcinoma (HCC). We report a unique case of an AFP-producing gastric cancer in an elderly man with known chronic hepatitis B (HBV) and a markedly elevated AFP. Thorough diagnostic imaging failed to reveal a HCC, but a gastric adenocarcinoma was found on endoscopy. After successful resection, the serum AFP normalized. On histopathologic examination, the cancer demonstrated focal positive staining for AFP, in keeping with a hepatoid gastric adenocarcinoma. Endoscopy should be considered in clinical situations where increased serum AFP is detected but no HCC is found.
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Ogasawara N, Takahashi E, Matsumoto T, Amaike M, Nohara M, Nagao K, Ebi M, Funaki Y, Sasaki M, Kasugai K. Prolonged Survival in a Case of Chemotherapy-Sensitive Gastric Cancer That Produced Alpha-Fetoprotein and Protein Induced by Vitamin K Antagonist-II. Case Rep Gastroenterol 2015; 9:113-9. [PMID: 26034473 PMCID: PMC4448069 DOI: 10.1159/000382072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The number of reported cases of alpha-fetoprotein (AFP)-producing gastric cancer has gradually increased, with a reported prevalence of 1.3–1.5% of all gastric cancer cases. However, reports of gastric cancer accompanied by elevated serum levels of both AFP and protein induced by vitamin K antagonist-II (PIVKA-II) are rare. The prognosis of AFP- and PIVKA-II-producing gastric cancer has been reported to be very poor because the tumor cells were considered to have a high malignant potential and the cancer progressed rapidly. We described a case of gastric cancer producing AFP and PIVKA-II in which chemotherapy was effective and resulted in prolonged survival, and these two tumor markers were useful for monitoring the treatment response. Routine health screening using upper abdominal ultrasonography revealed hepatic tumors in an apparently healthy 65-year-old man. Whole-body computed tomography (CT) revealed multiple hepatic tumors, and an esophagogastroduodenoscopy (EGD) revealed a Bormann type 3 tumor in the lower stomach. A biopsy specimen confirmed that the tumor was immunohistochemically positive for AFP, PIVKA-II, and human epidermal growth factor receptor 2. After chemotherapy, the gastric tumor appeared as a small elevated lesion on EGD, and CT revealed a remarkable reduction in the size of the metastatic liver tumors. The patient is still alive, 35 months after the initial chemotherapy.
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Affiliation(s)
- Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Emiko Takahashi
- Department of Pathology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Tomoko Matsumoto
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Manami Amaike
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mako Nohara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kazuhiro Nagao
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yasushi Funaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
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Wang D, Li C, Xu Y, Xing Y, Qu L, Guo Y, Zhang Y, Sun X, Suo J. Clinicopathological characteristics and prognosis of alpha-fetoprotein positive gastric cancer in Chinese patients. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:6345-6355. [PMID: 26261510 PMCID: PMC4525844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/29/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE This study aimed to review the clinicopathological, histochemical, and prognostic features of Alpha-Fetoprotein (AFP) positive gastric cancer. PATIENTS AND METHODS Six hundred and fifty one patients with gastric cancer who underwent gastrectomy between January 2009 and December 2012 at The First Hospital of Jilin University were enrolled in the study. Among them, 45 patients were identified as AFP positive gastric cancer. The clinicopathologic characteristics and prognosis of the AFP positive gastric cancer patients were analyzed. RESULTS Among the 45 AFP positive patients, serum levels of AFP were < 100 µg/L in nine patients. The histological classification of 45 patients was as follows: hepatoid type, 25 (55.6%) cases; fetal gastrointestinal type, 12 (26.7%) cases; yolk sac tumor type, 2 (4.4%) cases; and mixed type, 6 (13.3%) cases. Twenty nine (64.4%) cases were AFP positive by immunohistochemical analysis; we found no significant difference in AFP positivity and histologic type. However, the differences in the number of metastasis lymph nodes, the maximum tumor diameter, pathological stage, vascular invasion and liver metastasis between the AFP positive group and the negative group were significant. At the same T stage, the liver metastasis status of the AFP positive group was higher than that of the negative group. The AFP positive group had a much poorer prognosis than the negative group. CONCLUSION AFP positive gastric cancer is associated with aggressive behavior and poorer prognosis compared to that of AFP negative gastric cancer.
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Affiliation(s)
- Daguang Wang
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Chunping Li
- Department of Anesthesiology, The First Hospital, Jilin UniversityChangchun, China
| | - Yuechao Xu
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Yanpeng Xing
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Limei Qu
- Department of Pathology, The First Hospital, Jilin UniversityChangchun, China
| | - Yuchen Guo
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Xuan Sun
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Jian Suo
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
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Chang TS, Wu YC, Tung SY, Wei KL, Hsieh YY, Huang HC, Chen WM, Shen CH, Lu CH, Wu CS, Tsai YH, Huang YH. Alpha-Fetoprotein Measurement Benefits Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis. Am J Gastroenterol 2015; 110:836-44; quiz 845. [PMID: 25869392 DOI: 10.1038/ajg.2015.100] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/09/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Liver cirrhosis is a major risk factor for hepatocellular carcinoma (HCC), and all liver study societies recommend HCC surveillance in patients with cirrhosis. However, no ideal modality for HCC surveillance has been determined. The aim of this study is to assess the effectiveness of α-fetoprotein (AFP) measurement in HCC surveillance. METHODS In this retrospective analysis, all patients with cirrhosis, who received HCC surveillance through ultrasound (US) and AFP measurement between January 2002 and July 2010, were followed up until June 2013. The performance effectiveness of surveillance using AFP, US, or both in HCC detection was compared. RESULTS Overall, 1,597 patients were followed for a median duration of 4.75 (range 1.42-12) years. Over the 8563.25-person-year follow-up period, 363 patients (22.7%) developed HCCs. For HCC detection, the area under the receiver operator characteristic curve of surveillance AFP was 0.844 (95% confidence interval: 0.820-0.868, P<0.001). When the traditional cutoff value of 20 ng/ml was used, the sensitivity and specificity of AFP were 52.9% and 93.3%, respectively. US exhibited a sensitivity and specificity of 92.0% and 74.2%, respectively. A combination of US and AFP exhibited a sensitivity and specificity of 99.2% and 68.3%, respectively. By using cut-off at 20 ng/ml and AFP level increase ≥2 × from its nadir during the previous 1 year, the combination of US and AFP yielded a sensitivity of 99.2% and an improved specificity of 71.5%. CONCLUSIONS The complementary use of AFP and US improved the effectiveness of HCC surveillance in patients with cirrhosis.
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Affiliation(s)
- Te-Sheng Chang
- 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan [3] Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chih Wu
- Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shui-Yi Tung
- 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Liang Wei
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yung-Yu Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hao-Chun Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Ming Chen
- 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Heng Shen
- 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Hsien Lu
- 1] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan [2] Department of Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Shyong Wu
- 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Huang Tsai
- 1] College of Medicine, Chang Gung University, Taoyuan, Taiwan [2] Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Hua Huang
- 1] Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan [2] Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan [3] Center for Reproductive Medicine, Taipei Medical University Hospital, Taipei, Taiwan [4] Comprehensive Cancer Center of Taipei Medical University, Taipei, Taiwan [5] Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei, Taiwan
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15
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Ren A, Cai F, Shang YN, Ma ES, Huang ZG, Wang W, Luo J. Gastric hepatoid adenocarcinoma: A computed tomography report of six cases. World J Gastroenterol 2014; 20:15001-15006. [PMID: 25356063 PMCID: PMC4209566 DOI: 10.3748/wjg.v20.i40.15001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/07/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
We describe the computed tomography (CT) imaging findings in six cases (five males and one female; age range 61-78 years; mean age 67.3 years) with histologically proven hepatoid adenocarcinoma of the stomach (HAS). Five of the six patients had elevated serum alpha-fetoprotein levels. The most common type of gross appearance HAS on CT is a polypoid mass (83%, 5/6). The most common contrast enhancement pattern was heterogeneous. All six patients had a regional lymphadenopathy larger than 6 mm in its short axis. Liver metastases (n = 3) were noted. Venous tumor thrombosis was identified in the portal vein (n = 2) of the regions near primary gastric tumors or metastatic masses. Our findings suggest in an elderly, male patients with a large heterogeneous enhancement tumor, the presence of distant metastases, regional lymphadenopathy and characteristically increased serum alpha-fetoprotein levels indicates a high likelihood of HAS.
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16
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Elevated paraneoplastic hypercholesterolemia in a case of hepatoid adenocarcinoma of the stomach with liver metastasis. Clin J Gastroenterol 2013; 6:424-8. [PMID: 26182131 DOI: 10.1007/s12328-013-0420-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
A 67-year-old man was admitted to our hospital because of a large liver tumor revealed by ultrasonography. Laboratory data showed increased serum levels of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP), which are tumor markers for hepatocellular carcinoma. In addition, the serum cholesterol level was extremely high. Endoscopic examination revealed advanced gastric cancer. Histological findings of the stomach and liver tumor showed they were both hepatoid adenocarcinomas and were both positive for antibodies against AFP as well as DCP, suggesting that the tumors were gastric cancer with liver metastasis. Moreover, 3-hydroxyl-3-methylglutaryl coenzyme A (HMG-CoA) reductase, a key enzyme for regulation of cholesterol synthesis, was upregulated in the tumor tissues. Accordingly, we diagnosed this patient with AFP- and DCP-producing gastric cancer accompanied by paraneoplastic hypercholesterolemia. Paraneoplastic hypercholesterolemia is sometimes seen in hepatocellular carcinoma, but never in gastric cancer. This case is interesting because of the feature of hepatoid adenocarcinoma.
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17
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Inamoto O, Maki A, Araki H, Yamashita K, Okamura R, Kurahashi Y, Shinohara H, Shirakata Y, Mizuno Y, Mimura R. A Case of Long-Term Surviving AFP-producing Gastric Cancer with Liver Metastases Treated by Three Liver Resections. ACTA ACUST UNITED AC 2013. [DOI: 10.5833/jjgs.2012.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Liu X, Sheng W, Wang Y. An analysis of clinicopathological features and prognosis by comparing hepatoid adenocarcinoma of the stomach with AFP-producing gastric cancer. J Surg Oncol 2012; 106:299-303. [PMID: 22389029 DOI: 10.1002/jso.23073] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 02/03/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the differences between alpha-fetoprotein-producing gastric cancer (AFPPGC) and hepatoid adenocarcinoma of the stomach (HAS), and the clinicopathologic features and prognosis of HAS. METHODS From 1996 to 2007, there were 111 patients with elevated serum level of alpha-fetoprotein (AFP) preoperatively in Fudan University Shanghai Cancer Center. Primary lesions of 104 patients were stained positively for AFP. Among these patients, 45 patients were diagnosed as HAS. The clinicopathologic characteristics and prognostic factors of AFPPGC and HAS were analyzed. Additionally, 208 stage-matched AFP-negative gastric cancer patients were selected as control. RESULTS Immunohistochemically, the tumor cells were positive for AFP in AFPPGC. Histologically, the polygonal tumor cells were arranged in trabecular fashion or solid nests separated by narrow fibrous stroma composed of sinusoid-like capillaries in HAS. The survival rates of the three groups were statistically different (P < 0.01). CONCLUSION AFP-producing gastric cancer and HAS had more aggressive behavior than that of common gastric cancer. The prognosis of HAS was poorer than that of AFPPGC, therefore it should be distinguished from the latter.
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Affiliation(s)
- Xiaowen Liu
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
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19
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Liu X, Cheng Y, Sheng W, Lu H, Xu Y, Long Z, Zhu H, Wang Y. Clinicopathologic features and prognostic factors in alpha-fetoprotein-producing gastric cancers: analysis of 104 cases. J Surg Oncol 2010; 102:249-55. [PMID: 20740583 DOI: 10.1002/jso.21624] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES There were no comprehensive studies on the clinicopathologic features and prognosis of alpha-protein-producing gastric cancer. The aim of this study was to elucidate the clinicopathologic characteristics and prognostic factors of alpha-fetoprotein (AFP)-producing gastric cancer. METHODS Among 4,426 gastric cancer patients receiving surgery in the Cancer Hospital of Fudan University from 1996 to 2007, there were 111 patients with elevated serum level of AFP preoperatively after excluding chronic hepatitis, hepatocirrhosis, and hepatocellular carcinoma. Primary lesions of 104 patients were stained positively for AFP. The clinicopathologic characteristics and prognostic factors of AFP-producing gastric cancer were analyzed. Additionally, 208 stage-matched AFP-negative gastric cancer patients were selected as control. RESULTS There was a significantly higher incidence of vascular invasion, lymph node metastasis, and liver metastasis in AFP-positive group than in the negative group. The overall 5-year survival rates of AFP-positive and negative groups were 28% and 38%, respectively. The AFP-positive group had a significantly poorer survival in comparison to the stage-matched negative group. The independent prognostic factors of AFP-positive group included liver metastasis and pathological stage. CONCLUSIONS AFP-positive gastric cancer had more aggressive behavior than that of AFP-negative gastric cancer. In addition to surgery, multimodal therapy should be considered.
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Affiliation(s)
- Xiaowen Liu
- Department of Abdominal Surgery, Cancer Hospital, Fudan University, Shanghai, PR China
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20
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SALL4 represents fetal gut differentiation of gastric cancer, and is diagnostically useful in distinguishing hepatoid gastric carcinoma from hepatocellular carcinoma. Am J Surg Pathol 2010; 34:533-40. [PMID: 20182341 DOI: 10.1097/pas.0b013e3181d1dcdd] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The novel stem cell marker SALL4 has been identified as a diagnostic marker of germ cell tumors, especially yolk sac tumors, in gonadal organs. To clarify the significance of SALL4 as an oncofetal protein, we investigated SALL4 expression by immunohistochemistry in non-neoplastic stomach and gastric carcinoma with particular emphasis on á-fetoprotein (AFP)-producing gastric carcinoma, as AFP-producing gastric carcinoma shares expression of AFP and glypican 3 (GPC3) with yolk sac tumors and hepatic neoplasms. A total of 338 gastric carcinomas, 60 hepatocellular carcinomas, and 48 cholangiocellular carcinomas were studied by immunohistochemistry on tissue microarrays. In addition, more detailed whole tissue section immunohistochemistry was performed on non-neoplastic gastric tissue from 5 adult and 8 fetal specimens, 6 hepatoblastomas, and 31 cases of AFP-producing gastric carcinomas. SALL4 expression was observed in the neofetal stomach in gestational week 9 and disappeared thereafter. It was also identified by tissue microarray study in a fraction of gastric carcinomas (51 of 338, 15%), associated with older age (P=0.0001), male sex (P=0.0033), intestinal-type histology (P=0.0001), and synchronous liver metastasis (P=0.0047). AFP and GPC3 were closely associated with SALL4 expression in gastric carcinoma (both, P<0.0001), and a full-section study indicated that SALL4 was positive in all 31 cases of AFP-producing gastric carcinoma with diffuse staining in 24 cases (78%). Diffuse SALL4 expression was observed in the histologic patterns of hepatoid (89%), glandular (57%), and clear cell (39%) AFP-producing gastric carcinoma. In addition, SALL4 expression was completely negative in hepatoblastoma (n=6) and hepatocellular carcinoma (n=60). SALL4 is an oncofetal protein similar to AFP and GPC3, but it represents fetal gut differentiation in gastric carcinoma. SALL4 is a sensitive marker for AFP-producing gastric carcinoma and is especially useful to distinguish hepatoid gastric carcinoma from hepatocellular carcinoma.
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Sohn YJ, Jang JS, Choi SR, Kwon HC, Jung GJ, Kim MC, Jeong JS. Early detection of recurrence after endoscopic treatment for early gastric cancer. Scand J Gastroenterol 2010; 44:1109-14. [PMID: 19593687 DOI: 10.1080/00365520903121701] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Although there have been many reports regarding clinical outcomes of endoscopic treatment for early gastric cancer (EGC), little is known about detection of recurrence after endoscopic submucosal dissection (ESD). This study aims to clarify the clinical value of serological marker or imaging tools, including conventional CT and PET-CT scans, in detecting recurrent gastric cancer after ESD in Korea. MATERIAL AND METHODS From July 2004 to March 2008, 212 patients who had received ESD for EGC were enrolled in the study. For preoperative staging, conventional CT and PET-CT scans were performed in 141 patients, and for detection of recurrence of cancer, conventional CT, PET-CT scans and tumour marker; CEA, CA19-9, AFP were checked in 165 patients. RESULTS The local recurrence rate was 4.7% (10/212) during the study period. At 9 months after endoscopic treatment, 3 cases recurred. Four showed recurrence at 12 months, 2 at 18 months and 1 at 24 months. The positive rate was 7.1% (10/141) in conventional CT and 0% (0/24) in PET-CT scans for preoperative staging. Conventional CT and PET-CT scans could not detect local recurrence of cancer during the follow-up period. Tumour markers did not show any significant correlation with recurrence of cancer. CONCLUSIONS The study suggests that conventional CT, PET-CT scans and tumour marker have no role in the primary surveillance of early gastric cancer and/or in detecting recurrence after endoscopic treatment. For early diagnosis of recurrence after endoscopic treatment, a biopsy specimen from the endoscopic examination has to be obtained at regular intervals.
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Affiliation(s)
- You Jung Sohn
- Department of Internal Medicine, Dong-A Medical Center, University of College of Medicine, Busan, Korea
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22
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Jeong EH, Kim DH, Ma SH, Chung EJ, Bae SS, Park AY, Chu HJ. [A case of liver metastasis of gastric hepatoid adenocarcinoma]. THE KOREAN JOURNAL OF HEPATOLOGY 2009; 15:201-8. [PMID: 19581772 DOI: 10.3350/kjhep.2009.15.2.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report herein a case of hepatoid adenocarcinoma of the stomach with liver metastasis. Gastric carcinoma generally presents as adenocarcinoma and rarely shows a hepatoid pattern, which can produce alpha-fetoprotein (AFP). The stomach is one of the common sites at which hepatoid adenocarcinoma has been detected. A 75-year-old female patient was admitted to the hospital with a symptom of epigastric discomfort. Gastrofibroscopy revealed a large tumor occupying the greater curvature of the stomach body. The level of serum AFP was markedly increased. Abdominal computed tomography revealed multiple liver masses. Biopsy samples of the gastric lesion and liver masses finally confirmed her case as hepatoid adenocarcinoma in the stomach with liver metastasis. The AFP-producing gastric carcinoma needs special attention because it often presents with early liver metastasis and has a poor prognosis.
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Affiliation(s)
- Eun Hyoung Jeong
- Department of Internal Medicine, Hong Ik General Hospital, Seoul, Korea
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23
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Alpha-fetoprotein expressing metastastic adenocarcinoma of the esophago-gastric junction responding favorably to capecitabine and oxaliplatin. Anticancer Drugs 2009; 20:75-8. [PMID: 19343004 DOI: 10.1097/cad.0b013e328312659a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Alpha-fetoprotein-producing metastatic adenocarcinoma of the stomach or the esophago-gastric junction usually exhibits either no or only short-term remission while receiving palliative chemotherapy. We report on a 76-year-old male patient suffering from an unresectable alpha-fetoprotein-producing adenocarcinoma of the esophago-gastric junction with several liver metastases. He was treated with capecitabine and oxaliplatin-based combination therapy. A long-lasting major remission was observed resulting in a survival of 18.5 months.
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Hanaoka N, Tanabe S, Higuchi K, Sasaki T, Nakatani K, Ishido K, Ae T, Koizumi W, Saigenji K, Mikami T. A rare case of histologically mixed-type intramucosal gastric cancer accompanied by nodal recurrence and liver metastasis after endoscopic submucosal dissection. Gastrointest Endosc 2009; 69:588-90. [PMID: 19136109 DOI: 10.1016/j.gie.2008.05.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 05/12/2008] [Indexed: 12/10/2022]
Affiliation(s)
- Noboru Hanaoka
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara-City, Kanagawa, Japan
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25
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Park DE, Lee HB, Chae KM. Hepatoid Adenocarcinoma of the Stomach Misconceived as a Primary Liver Tumor. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.6.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dong Eun Park
- Department of Surgery, Wonkwang University College of Medicine, Iksan, Korea
| | - Han Beom Lee
- Department of Surgery, Wonkwang University College of Medicine, Iksan, Korea
| | - Kwon Mook Chae
- Department of Surgery, Wonkwang University College of Medicine, Iksan, Korea
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26
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Igarashi H, Shinozaki S, Mukada T. A case of acinar cell carcinoma of the pancreas that formed extensive tumor thrombus of the portal vein. Clin J Gastroenterol 2008; 2:96-102. [PMID: 26192173 DOI: 10.1007/s12328-008-0044-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 10/01/2008] [Indexed: 11/24/2022]
Abstract
A 58-year-old man was admitted to our hospital because of anorexia and back pain. He had been previously diagnosed with chronic pancreatitis with blood thrombus of the splenic vein at another hospital. Abdominal ultrasonography and computed tomography revealed a large mass in the body and tail of the pancreas, which directly invaded the stomach and the spleen. Small nodular metastases in both lungs were also detected. Furthermore, tumor thrombus continuously involved the splenic and proximal superior mesenteric vein, main portal vein, and its right intrahepatic branch. A metastatic mass was disclosed in the adjacent liver. The specimens obtained from portal tumor thrombus were histologically compatible with acinar cell carcinoma. Portal tumor thrombus is a rare condition in pancreatic tumors; however, it seems to be important to differentiate tumor thrombus from blood thrombus of the portal vein in order to know the true clinical stage and provide a suitable treatment.
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Affiliation(s)
- Hiroaki Igarashi
- Department of Gastroenterology, Kawakita Hospital, 1-7-3 Asagayakita, Suginami, Tokyo, 166-8488, Japan.
| | - Sachiko Shinozaki
- Department of Internal Medicine, Okubo Hospital, Shinjuku, Tokyo, Japan
| | - Takeo Mukada
- Department of Internal Medicine, Gunma Chuo Sogo Hospital, Maebashi, Gunma, Japan
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27
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Sentani K, Oue N, Sakamoto N, Arihiro K, Aoyagi K, Sasaki H, Yasui W. Gene expression profiling with microarray and SAGE identifies PLUNC as a marker for hepatoid adenocarcinoma of the stomach. Mod Pathol 2008; 21:464-75. [PMID: 18204429 DOI: 10.1038/modpathol.3801050] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastric cancer is one of the most common malignancies worldwide. In this study, we screened for genes upregulated in gastric cancer by comparing gene expression profiles from serial analysis of gene expression and microarray and identified the palate, lung, and nasal epithelium carcinoma-associated protein (PLUNC) gene. Immunostaining for PLUNC in 140 gastric cancer cases revealed strong and extensive staining of PLUNC in hepatoid adenocarcinoma of the stomach, whereas 7% of conventional gastric cancer cases showed focal immunostaining of PLUNC. Gastric hepatoid adenocarcinoma is an extrahepatic tumor characterized by morphologic similarities to hepatocellular carcinoma. To investigate the utility of PLUNC immunostaining in the diagnosis of gastric hepatoid adenocarcinoma, six cases of gastric hepatoid adenocarcinoma (six primary tumors and two associated liver metastases) were studied further. PLUNC staining was observed in all six primary hepatoid adenocarcinomas. PLUNC staining was observed in both the hepatoid adenocarcinoma and tubular/papillary adenocarcinoma components of primary tumors, although PLUNC staining was preferentially localized in tubular/papillary adenocarcinoma components. Staining of PLUNC was also detected in both liver metastases. PLUNC staining was not observed in 52 cases of primary hepatocellular carcinoma or in normal adult or fetal liver. These results indicate that PLUNC is a novel marker that distinguishes gastric hepatoid adenocarcinoma from primary hepatocellular carcinoma.
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Affiliation(s)
- Kazuhiro Sentani
- Department of Molecular Pathology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Tahara H, Hirokawa T, Oyama T, Naganuma A, Maruta S, Ban S, Yoshida K, Takagi H, Mori M. Gastric yolk sac tumor complicated with beta-human chorionic gonadotropin-producing metastases. Intern Med 2008; 47:2145-9. [PMID: 19075540 DOI: 10.2169/internalmedicine.47.1385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This report describes the case of 74-year-old man who had a gastric yolk sac tumor complicated with beta human chorionic gonadotropin (beta hCG) producing metastases. He was a heavy drinker. He was admitted to the hospital for abdominal pain and fullness. Based on computed tomography and gastric endoscopy he was diagnosed to have gastric cancer that had metastasized to the liver, lung and lymph nodes. The level of serum alpha fetoprotein (AFP) was high at 523 ng/mL. He died of multiorgan failure six days after admission. The autopsy revealed the stomach tumor to be an AFP-positive yolk sac tumor. Lymph node metastases showed the same characteristics as the stomach tumor. However, the lesions on the liver and lung were negative for AFP and positive for hCG. The yolk sac tumor seemed to have retrodifferentiated to form an hCG-producing tumor in the metastatic lesions. A gastric yolk sac tumor is extremely rare and only eight cases of gastric yolk sac tumors have been previously reported in the literature. To avoid a misdiagnosis, careful attention should be paid to the above-mentioned morphological features and immunohistochemical findings, in addition to the clinical findings.
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Affiliation(s)
- Hiroki Tahara
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi.
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29
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Shibata Y, Sato K, Kodama M, Nanjyo H. Alpha-Fetoprotein-Producing Early Gastric Cancer of the Remnant Stomach: Report of a Case. Surg Today 2007; 37:995-9. [DOI: 10.1007/s00595-007-3501-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 02/21/2007] [Indexed: 10/22/2022]
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30
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Sohda T, Tomioka Y, Inomata S, Morita I, Eguchi K, Aoyagi K, Watanabe H, Nakamura S, Sakisaka S. Alpha-fetoprotein (AFP)- and des-gamma-carboxy prothrombin (DCP)-producing adenocarcinoma of the stomach with liver metastasis in a patient with chronic hepatitis C. Intern Med 2005; 44:294-8. [PMID: 15897638 DOI: 10.2169/internalmedicine.44.294] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 45-year-old man was admitted to our hospital because of chronic hepatitis C and a large liver tumor accompanied by increased serum levels of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP), the tumor markers for hepatocellular carcinoma. Endoscopic examination revealed advanced gastric cancer. Biopsy specimens of the stomach and liver showed gastric adenocarcinoma and its metastasis to the liver. Immunohistochemical studies demonstrated that adenocarcinoma cells both of the stomach and liver, were positive for the antibodies against AFP as well as DCP. Expression of AFP mRNA was shown in the cancer cells of the stomach. Accordingly, we diagnosed this patient with AFP- and DCP-producing adenocarcinoma of the stomach together with liver metastasis.
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Affiliation(s)
- Tetsuro Sohda
- Third Department of Medicine, Fukuoka University, School of Medicine, Fukuoka
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31
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Abstract
A 54-year-old man presented to his doctor with hematemesis and was found at endoscopy to have an ulcerated lesion in his stomach. A computed tomography scan was performed and revealed a mass in the fundus of the stomach. Multiple other lesions were identified in the liver, lungs, retroperitoneal space, and mesentery. Gross examination showed two separate gastric lesions containing nests and single cells with mucin intermixed with sheets of tumor cells with abundant eosinophilic cytoplasm invading throughout the wall of the stomach. Immunohistochemical studies were performed and the cells were positive for hepatocyte, MOC 31, cytokeratin A1/A3, and CK 7, and were negative for CK 20, alpha-fetoprotein, and thyroid transcription factor. The histologic features together with the immunohistochemical findings were diagnostic of a hepatoid adenocarcinoma of the stomach. Hepatoid adenocarcinoma is a rare tumor associated with a very poor prognosis. Immunohistochemical studies may help to identify the characteristic features of hepatoid differentiation and prevent mistaking this tumor for other types of carcinoma.
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Affiliation(s)
- Jose Antonio Plaza
- Department of Pathology and Radiology, The Ohio State University Medical Center, 410 West 10th Avenue, Columbus, OH 43210, USA
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32
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Hirasaki S, Tanimizu M, Tsuzuki T, Tsubouchi E, Hidaka S, Hyodo I, Tajiri H. Seronegative alpha-fetoprotein-producing early gastric cancer treated with endoscopic mucosal resection and additional surgery. Intern Med 2004; 43:926-30. [PMID: 15575241 DOI: 10.2169/internalmedicine.43.926] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 67-year-old man visited our hospital for the treatment of gastric carcinoma. Endoscopic mucosal resection was performed, however, histological examination of the resected specimen revealed tumor invasion to the submucosal layer with vessel invasion. Immunohistological studies were carried out on resected specimens and part of the cancerous lesion showed a positive reaction for alpha-fetoprotein (AFP), but the serum AFP level was normal. Additional distal gastrectomy with lymph node dissection revealed lymph node metastasis although there was no apparent finding of lymph node swelling by preoperative diagnostic imaging. This patient remains alive without disease for 3 years after surgery.
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Affiliation(s)
- Shoji Hirasaki
- Department of Internal Medicine, Shikoku Cancer Center, 13 Horino-uchi, Matsuyama 790-0007
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Hirao K, Hirasaki S, Tsuzuki T, Kajiwara T, Hyodo I. Unresectable alpha fetoprotein-producing gastric cancer successfully treated with irinotecan and mitomycin C after S-1 failure. Intern Med 2004; 43:106-10. [PMID: 15005251 DOI: 10.2169/internalmedicine.43.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Diagnostic imaging of a 70-year-old woman revealed widespread lymph node swelling and pyloric stenosis due to alpha fetoprotein-producing gastric cancer. Second line chemotherapy of irinotecan and mitomycin C was administered after S-1 failure. After 6 courses of 2nd line chemotherapy, pyloric stenosis was improved, and lymph node swelling disappeared. This patient has been alive without disease for more than 3 years since 2nd line chemotherapy began and for more than 4 years since her first admittance to our hospital. Second line chemotherapy may have contributed to the favorable clinical outcome in this patient.
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Affiliation(s)
- Ken Hirao
- Department of Internal Medicine, National Shikoku Cancer Center, 13 Horino-uchi, Matsuyama 790-0007
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34
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Terracciano LM, Glatz K, Mhawech P, Vasei M, Lehmann FS, Vecchione R, Tornillo L. Hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma: an immunohistochemical and molecular study of eight cases. Am J Surg Pathol 2003; 27:1302-12. [PMID: 14508391 DOI: 10.1097/00000478-200310000-00002] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatoid adenocarcinoma (HAC) is a special type of extrahepatic adenocarcinoma, which has a striking morphologic similarity to hepatocellular carcinoma. Seven HACs arising in the stomach and one in the lung, all with liver metastasis, were studied. They shared clinical features, such as old age, high serum alpha-fetoprotein level, aggressive behavior, and hepatic tumor in absence of risk factors for hepatocellular carcinoma (HCC). Morphologically, tumors were characterized by an admixture of tubulo-and/or papillary adenocarcinoma with hepatoid foci. In six cases, liver metastases showed an exclusive hepatoid differentiation, virtually indistinguishable from HCC with solid growth pattern. As HAC and HCC cannot be differentiated on the basis of morphology alone, differences in immunohistochemical reaction patterns would be of considerable diagnostic help. Immunostaining for CK7, CK8, CK18, CK19, CK20, alpha-fetoprotein, p-CEA, and HepPar1 revealed that hepatoid areas of both primary and metastatic HAC have a specific immunoprofile, distinctive of this entity. On the one hand, positivity of virtually all HACs for alpha-fetoprotein, CK8, CK18, and the membranous, canalicular staining for polyclonal carcinoembryonic antigen underline its hepatoid nature. On the other hand, positive staining for CK19 and CK20 and frequent negativity for HepPar1 in both primary tumors and their metastases were distinctive features of HAC. Furthermore, HAC differs from combined hepatocellular cholangiocarcinoma, being negative for CK7. In addition, for comparison of immunohistochemical results, we stained with the same antibody panel a tissue microarray of 121 HCCs. Comparative genomic hybridization study of three HAC supports their hepatoid differentiation as aberrations found in HAC are common in HCC (4q-, 8p-), and hepatoblastoma (Xq+), respectively.
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Affiliation(s)
- Luigi M Terracciano
- Institute of Pathology, Schönbeinstrasse 40, University Hospital Basel, 4003 Basel, Switzerland.
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Trompetas V, Varsamidakis N, Frangia K, Polimeropoulos V, Kalokairinos E. Gastric hepatoid adenocarcinoma and familial investigation: does it always produce alpha-fetoprotein? Eur J Gastroenterol Hepatol 2003; 15:1241-4. [PMID: 14560160 DOI: 10.1097/00042737-200311000-00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We present the case of a 68-year-old Caucasian man with gastric hepatoid adenocarcinoma without increased levels of alpha-fetoprotein (AFP) in the serum. The patient had a strong history of gastric cancer in his family, affecting seven members, including a brother and a sister. The patient underwent subtotal gastrectomy, but 4 months later presented hepatic metastases, and 6 months after the initial diagnosis he succumbed to the disease. Immunohistochemical tests showed that the tumour was positive for AFP, hepatocyte paraffin 1, and neuron-specific enolase, but negative for synaptophysin and chromogranin. Previously reported cases of hepatoid gastric tumours showed that they produce large amounts of AFP and that they have a poor prognosis.
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Affiliation(s)
- Vasilis Trompetas
- First Department of Surgery, The Athens General Hospital 'G Gennimatas', Greece.
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Akiyama S, Tamura G, Endoh Y, Fukushima N, Ichihara Y, Aizawa K, Kawata S, Motoyama T. Histogenesis of hepatoid adenocarcinoma of the stomach: molecular evidence of identical origin with coexistent tubular adenocarcinoma. Int J Cancer 2003; 106:510-515. [PMID: 12845645 DOI: 10.1002/ijc.11246] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hepatoid adenocarcinoma of the stomach is a highly malignant neoplasm. Most gastric hepatoid adenocarcinomas coexist with tubular adenocarcinoma. However, the relationship between hepatoid adenocarcinoma and tubular adenocarcinoma is still unclear. In the present study, the characteristics of the coexistent tubular adenocarcinomas were determined by examining their profiles of mucin production. Subsequently, molecular pathological techniques were applied to determine the clonality of 15 mixed hepatoid and tubular adenocarcinomas of the stomach. Mucin analysis suggested that the coexistent tubular adenocarcinomas with hepatoid adenocarcinoma were of the intestinal type. The patterns of chromosome X inactivation were identical between the hepatoid adenocarcinoma component and tubular adenocarcinoma component in all of 3 informative female cases. Mutations in the p53 gene were found in 5 cases. The sequences were identical within both tumor components in all 5 cases. Microsatellite analysis indicated more than 3 common patterns of loss of heterozygosity in 8 cases. These observations strongly suggested that hepatoid adenocarcinomas were of identical origin to coexistent tubular adenocarcinomas.
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Affiliation(s)
- Sunao Akiyama
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan
- Department of Internal Medicine, Yamagata University School of Medicine, Yamagata, Japan
| | - Gen Tamura
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yasushi Endoh
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan
| | | | - Yukihiro Ichihara
- Department of Surgery, Prefectural Central Hospital, Yamagata, Japan
| | - Kikuo Aizawa
- Department of Surgery, Tsubame Rosai Hospital, Tsubame, Japan
| | - Sumio Kawata
- Department of Internal Medicine, Yamagata University School of Medicine, Yamagata, Japan
| | - Teiichi Motoyama
- Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan
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37
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Yano T, Kishimoto T, Tomaru U, Kawarada Y, Kato H, Yoshiki T, Ishikura H. Further evidence of hepatic transdifferentiation in hepatoid adenocarcinomas of the stomach: quantitative analysis of mRNA for albumin and hepatocyte nuclear factor-4α. Pathology 2003. [DOI: 10.1080/0031302021000062389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Koide N, Nishio A, Igarashi J, Kajikawa S, Adachi W, Amano J. Alpha-fetoprotein-producing gastric cancer: histochemical analysis of cell proliferation, apoptosis, and angiogenesis. Am J Gastroenterol 1999; 94:1658-63. [PMID: 10364040 DOI: 10.1111/j.1572-0241.1999.01158.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Alpha-fetoprotein (AFP)-producing gastric cancer has been associated with a poor prognosis. In the present study, the cell proliferation, apoptosis, and angiogenesis of this cancer were studied histochemically to determine its malignant potential. METHODS Tissue samples were taken from four patients with AFP-producing gastric cancer and 26 patients with AFP-negative gastric cancer. Cell proliferation was evaluated by Ki-67 immunostaining, and the Ki-67 labeling index (LI) was determined. Apoptosis was studied by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling method, and the apoptotic index was determined. Angiogenesis was evaluated by measuring the microvessel density using factor VIII immunostaining, and immunostainings for vascular endothelial growth factor and thymidine phosphorylase were performed. RESULTS The Ki-67 LI of the AFP-producing gastric cancers was significantly higher than that of the AFP-negative gastric cancers (p < 0.01). The apoptotic index of the AFP-producing gastric cancers was significantly lower than that of the AFP-negative gastric cancers (p < 0.01). The microvessel density of the AFP-producing gastric cancers was significantly higher than that of the AFP-negative gastric cancers (p < 0.01). Vascular endothelial growth factor expression was observed in all four of the AFP-producing gastric cancers, whereas thymidine phosphorylase was not expressed in any of the AFP-producing gastric cancers. CONCLUSIONS These results suggest that AFP-producing gastric cancers have high malignant potential (high proliferative activity, weak apoptosis, and rich neovascularization) compared with that of AFP-negative gastric cancers. These biological characteristics of AFP-producing gastric cancer reflect the aggressive behavior and the poor prognosis of patients with this type of cancer.
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Affiliation(s)
- N Koide
- Second Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
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39
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Puglisi F, Damante G, Pizzolitto S, Mariuzzi L, Guerra S, Pellizzari L, Binotto F, Beltrami CA. Combined yolk sac tumor and adenocarcinoma in a gastric stump. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19990501)85:9%3c1910::aid-cncr5%3e3.0.co;2-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Puglisi F, Damante G, Pizzolitto S, Mariuzzi L, Guerra S, Pellizzari L, Binotto F, Beltrami CA. Combined yolk sac tumor and adenocarcinoma in a gastric stump. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19990501)85:9<1910::aid-cncr5>3.0.co;2-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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41
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Nakata Y, Watanabe Y, Nakata T, Kimura K, Sato M, Kawachi K. Early gastric cancer associated with synchronous liver metastasis and portal tumorous embolism: report of a case. Surg Today 1998; 28:753-7. [PMID: 9697271 DOI: 10.1007/bf02484624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report herein the first known case of early gastric cancer with synchronous liver metastasis forming a portal tumorous embolism. A 62-year-old man was found to have multiple liver tumors and a portal tumorous embolism by ultrasonography. A gastroscopy subsequently showed Borrmann type III-like gastric cancer in the antrum. His carbohydrate antigen (CA) 19-9 level was elevated to 8280 U/ml, but the alpha-fetoprotein level was within normal limits. A laparotomy revealed multiple liver metastasis and subpyrolic lymph-node enlargement; a distal partial gastrectomy with group 1 lymph-node dissection for the gastric cancer in the antrum, and cannulation of the proper hepatic artery for postoperative chemotherapy were performed. Histopathologically, the cancer was found to be a medullary type well-differentiated adenocarcinoma. Subpyrolic lymph node metastasis was noted, but cancer invasion was localized to only the mucosal and submucosal layers of the stomach. Thus, the patient was diagnosed as having early gastric cancer. Adjuvant chemotherapy given through the cannula suppressed further elevation of CA19-9 levels, and a total of 26 Gy irradiation to a liver tumor, which had caused ascites by pressing on the inferior vena cava, diminished the ascites. The patient was able to remain at home with treatment for 7 months after radiation therapy, but finally died of cancer with jaundice 13 months after his operation. Therefore, although adjuvant chemotherapy and radiation therapy contributed to improving his quality of life, it could not prolong survival.
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Affiliation(s)
- Y Nakata
- Department of Surgery, Kitaishikai Hospital, Ehime, Japan
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42
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Roberts CC, Colby TV, Batts KP. Carcinoma of the stomach with hepatocyte differentiation (hepatoid adenocarcinoma). Mayo Clin Proc 1997; 72:1154-60. [PMID: 9413299 DOI: 10.4065/72.12.1154] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case of hepatoid adenocarcinoma of the stomach is reported, and the literature is reviewed. The stomach is one of the most common sites in which hepatoid adenocarcinomas have been detected. Of the 59 cases reviewed from the literature (including the current case), a 2:1 male predominance was noted, and the serum alpha-fetoprotein level was almost always increased. All patients were adults, and most had evidence of metastases at the time of resection. Prognosis seems less favorable than that associated with the more common intestinal type of adenocarcinoma of the stomach. Hepatoid adenocarcinomas typically show periodic acid-Schiff-positive, diastase-resistant intracytoplasmic globules, which are demonstrated to be positive with antibodies to alpha-fetoprotein. The tumor cells resemble liver cells, and rare cases, including our own, have evidence of bile production. In our case, messenger RNA for albumin, unique to liver cells, was demonstrated by in situ hybridization of the tumor cells.
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Affiliation(s)
- C C Roberts
- Department of Radiology, University of Arizona Health Sciences Center, Tucson, USA
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43
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Lorenzi M, Vindigni C, Tripodi SA, Megha T, Mancini S, Francini G. Hepatoid Gastric Carcinoma. A Case Report. Int J Biol Markers 1996; 11:216-9. [PMID: 9017446 DOI: 10.1177/172460089601100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alpha-fetoprotein (AFP) is normally produced by primary hepatic neoplasms and germ cell tumors. There have, however, been reports of its production in cases of gastrointestinal tract adenocarcinoma. Gastric hepatoid carcinomas constitute a clinicopathological entity of recent acquisition and have certain common characteristics, which include the presence of hepatoid foci and frequent liver metastases, even in cases of early gastric cancer, and increasing serum AFP levels. In this study the case of one patient who underwent gastric resection and presented clinical, humoral, histological and immunohistochemical characteristics typical of hepatoid gastric carcinoma is reported. More biological studies, as well as precise criteria for pathological definition and therapy, are still necessary for a better understanding of this pathology.
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Affiliation(s)
- M Lorenzi
- Department of General Surgery III, University of Siena, Italy
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44
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Umekawa Y, Watanabe M, Ikeda S, Fukumoto S, Hirakawa H, Shimada Y. Alpha-fetoprotein-producing early gastric cancer accompanying liver cirrhosis: a case report. J Gastroenterol 1994; 29:66-70. [PMID: 7515308 DOI: 10.1007/bf01229076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A rare case of alpha-fetoprotein (AFP)-producing early gastric cancer with liver cirrhosis is presented. A 61-year-old man was admitted to Shimane Medical University Hospital in 1988 because of abnormal liver function test results suggestive of liver cirrhosis with mild elevation of AFP. Liver cirrhosis was confirmed laparoscopically and histologically. Gastric cancer was found in fluoroscopic and endoscopic studies. After partial gastrectomy, the serum AFP level fluctuated transiently within normal limits, and then gradually increased soon after the operation. Therefore, complication of hepatocellular carcinoma was suspected, but no tumor in the liver was detected by any imaging examination, including angiography. Two years after the operation, swelling of abdominal periaortic lymph nodes was noted at a periodic checkup, but still no hepatic tumor was found. At this point, AFP-producing gastric cancer was suspected, and an AFP staining test was carried out on the tissue of the resected specimen. AFP-positive cells were recognized immunohistochemically. Thus, we diagnosed the condition as post-operative recurrence of an AFP-producing gastric cancer accompanying liver cirrhosis.
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Affiliation(s)
- Y Umekawa
- Second Department of Internal Medicine, Shimane Medical University, Izumo, Japan
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45
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