BACKGROUND Gastric adenocarcinoma with enteroblastic differentiation(GAED)is one of the common subtypes of alpha-foetoprotein(AFP)-producing gastric cancer.GAED frequently results in venous invasion and liver metastas...BACKGROUND Gastric adenocarcinoma with enteroblastic differentiation(GAED)is one of the common subtypes of alpha-foetoprotein(AFP)-producing gastric cancer.GAED frequently results in venous invasion and liver metastasis,the latter being particularly linked to a poor prognosis.So far,the evidence for liver metastases from AFP-producing gastric cancer is only focused on those from gastric hepatoid adenocarcinoma,owing to their imaging similarities with hepatocellular carcinoma.This case report describes the characteristic diagnostic imaging findings of liver metastasis from GAED.CASE SUMMARY A 65-year-old man who had undergone a pyloric gastrectomy for GAED two years ago was found to have a liver tumor in the hepatic segment 7,accompanied by elevated serum AFP levels.Dynamic contrast-enhanced computed tomography revealed the tumor showing peripheral-dominant enhancement in the arterial phase with persistent central enhancement in the delayed phase.Gadoliniumethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging demonstrated a signal drop in the tumor periphery in chemical shift imaging,along with arterial enhancement.Additionally,rim-like hypointensity surrounding the tumor was observed in the hepatobiliary phase.Postresection examination confirmed the tumor to be a metastasis from GAED.Histopathological examination revealed severe invasion of the tumor into the portal vein and hepatic vein surrounding the tumor,which explained the imaging features.CONCLUSION The imaging features of blood flow alternations resulting from vascular invasion may be crucial to diagnosing liver metastases from GAED.展开更多
AIM To investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation(GCED).METHODS We retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early...AIM To investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation(GCED).METHODS We retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early stage conventional gastric cancer(CGC: well or moderately differentiated adenocarcinoma) who underwent endoscopic submucosal dissection or endoscopic mucosal resection from September 2011 to February 2015 in our hospital.GCED was defined as a tumor having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm and immunohistochemical positivity for either alpha-fetoprotein, Glypican 3 or SALL4. The following were compared between GCED and CGC: age, gender, location and size of tumor, macroscopic type, ulceration, depth of invasion, lymphatic and venous invasion, positive horizontal and vertical margin, curative resection rate.RESULTS Six cases(5 males, 1 female; mean age 75.7 years; 6 lesions) of early gastric cancer with a GCED component and 186 cases(139 males, 47 females; mean age 72.7 years; 209 lesions) of early stage CGC were investigated. Mean tumor diameters were similar but rates of submucosal invasion, lymphatic invasion, venous invasion, and non-curative resection were higher in GCED than CGC(66.6% vs 11.4%, 33.3% vs 2.3%, 66.6% vs 0.4%, 83.3% vs 11% respectively, P < 0.01). Deep submucosal invasion was not revealed endoscopically or by preoperative biopsy. Histologically, in GCED the superficial mucosal layer was covered with a CGC component. The GCED component tended to exist in the deeper part of the mucosa to the submucosa by lymphatic and/or venous invasion, without severe stromal reaction. In addition, Glypican 3 was the most sensitive marker for GCED(positivity, 83.3%), immunohistochemically.CONCLUSION Even in the early stage GCED has high malignant potential, and preoperative diagnosis is considered difficult. Endoscopists and pathologists should know the clinicopathological features of this highly malignant type of cancer.展开更多
BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(...BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(GAED)and hepatoid adenocarcinoma(HAC)were previously regarded as gastric adenocarcinoma with primitive enterocyte phenotype(GAPEP).GAPEP is known for its poor prognosis,and the accurate diagnosis of GAPEP directly affects therapeutic decision-making.Despite their poor prognosis and morphological heterogeneity,the molecular drivers of GAPEP,particularly methylation-driven mechanisms,remain poorly explored.AIM To investigate the clinicopathological and molecular characteristics of GAPEP and establish an integrative diagnostic strategy to guide therapeutic decision-making.METHODS Based on the expression profile and morphology,patients were divided into three groups:GAPEP(including GAED and HAC),conventional gastric cancer(CGC),and CGC expressing primitive phenotypic markers.We analyzed clinicopathological features and overall survival.Data from The Cancer Genome Atlas were also analyzed,and functional enrichment analysis was conducted.RESULTS GAPEP showed diverse morphology,and immunohistochemical staining alone was not adequate for accurate diagnosis.Histologically,GAPEP was characterized by large,polygonal tumor cells with supranuclear or subnuclear vacuoles,a“piano keyboard-like”appearance,and clear or eosinophilic cytoplasms.Compared to CGC and CGC expressing primitive phenotypic markers,GAPEP displayed more aggressive clinical features.Molecular analysis showed significant differences in molecular subtypes,TP53 mutation,ERBB2 amplification,ARID1A mutation,MSI status,and CpG island methylator phenotype category.Genomic analysis revealed that TP53 mutations,APC mutations,and ERBB2 amplifications were more frequent in GAPEP.Genes involved in methylation processes were highly upregulated in GAPEP.HAC and GAED shared similar clinicopathological and genetic characteristics.Functional enrichment analysis highlighted the critical role of methylation in the development of GAPEP.CONCLUSION The diversity and aggressiveness of GAPEP are driven by deregulated methylation,necessitating the integration of morphological and immunohistochemical diagnosis.Targeting methylation can provide new therapeutic opportunities for treating this aggressive cancer.展开更多
文摘BACKGROUND Gastric adenocarcinoma with enteroblastic differentiation(GAED)is one of the common subtypes of alpha-foetoprotein(AFP)-producing gastric cancer.GAED frequently results in venous invasion and liver metastasis,the latter being particularly linked to a poor prognosis.So far,the evidence for liver metastases from AFP-producing gastric cancer is only focused on those from gastric hepatoid adenocarcinoma,owing to their imaging similarities with hepatocellular carcinoma.This case report describes the characteristic diagnostic imaging findings of liver metastasis from GAED.CASE SUMMARY A 65-year-old man who had undergone a pyloric gastrectomy for GAED two years ago was found to have a liver tumor in the hepatic segment 7,accompanied by elevated serum AFP levels.Dynamic contrast-enhanced computed tomography revealed the tumor showing peripheral-dominant enhancement in the arterial phase with persistent central enhancement in the delayed phase.Gadoliniumethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging demonstrated a signal drop in the tumor periphery in chemical shift imaging,along with arterial enhancement.Additionally,rim-like hypointensity surrounding the tumor was observed in the hepatobiliary phase.Postresection examination confirmed the tumor to be a metastasis from GAED.Histopathological examination revealed severe invasion of the tumor into the portal vein and hepatic vein surrounding the tumor,which explained the imaging features.CONCLUSION The imaging features of blood flow alternations resulting from vascular invasion may be crucial to diagnosing liver metastases from GAED.
文摘AIM To investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation(GCED).METHODS We retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early stage conventional gastric cancer(CGC: well or moderately differentiated adenocarcinoma) who underwent endoscopic submucosal dissection or endoscopic mucosal resection from September 2011 to February 2015 in our hospital.GCED was defined as a tumor having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm and immunohistochemical positivity for either alpha-fetoprotein, Glypican 3 or SALL4. The following were compared between GCED and CGC: age, gender, location and size of tumor, macroscopic type, ulceration, depth of invasion, lymphatic and venous invasion, positive horizontal and vertical margin, curative resection rate.RESULTS Six cases(5 males, 1 female; mean age 75.7 years; 6 lesions) of early gastric cancer with a GCED component and 186 cases(139 males, 47 females; mean age 72.7 years; 209 lesions) of early stage CGC were investigated. Mean tumor diameters were similar but rates of submucosal invasion, lymphatic invasion, venous invasion, and non-curative resection were higher in GCED than CGC(66.6% vs 11.4%, 33.3% vs 2.3%, 66.6% vs 0.4%, 83.3% vs 11% respectively, P < 0.01). Deep submucosal invasion was not revealed endoscopically or by preoperative biopsy. Histologically, in GCED the superficial mucosal layer was covered with a CGC component. The GCED component tended to exist in the deeper part of the mucosa to the submucosa by lymphatic and/or venous invasion, without severe stromal reaction. In addition, Glypican 3 was the most sensitive marker for GCED(positivity, 83.3%), immunohistochemically.CONCLUSION Even in the early stage GCED has high malignant potential, and preoperative diagnosis is considered difficult. Endoscopists and pathologists should know the clinicopathological features of this highly malignant type of cancer.
基金Supported by the Startup Fund for Scientific Research,Fujian Medical University,No.2020QH1168Fujian Provincial Science and Technology Innovation Joint Funds,No.2024Y9023the Fujian Provincial Natural Science Foundation of China,No.2024J011644.
文摘BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(GAED)and hepatoid adenocarcinoma(HAC)were previously regarded as gastric adenocarcinoma with primitive enterocyte phenotype(GAPEP).GAPEP is known for its poor prognosis,and the accurate diagnosis of GAPEP directly affects therapeutic decision-making.Despite their poor prognosis and morphological heterogeneity,the molecular drivers of GAPEP,particularly methylation-driven mechanisms,remain poorly explored.AIM To investigate the clinicopathological and molecular characteristics of GAPEP and establish an integrative diagnostic strategy to guide therapeutic decision-making.METHODS Based on the expression profile and morphology,patients were divided into three groups:GAPEP(including GAED and HAC),conventional gastric cancer(CGC),and CGC expressing primitive phenotypic markers.We analyzed clinicopathological features and overall survival.Data from The Cancer Genome Atlas were also analyzed,and functional enrichment analysis was conducted.RESULTS GAPEP showed diverse morphology,and immunohistochemical staining alone was not adequate for accurate diagnosis.Histologically,GAPEP was characterized by large,polygonal tumor cells with supranuclear or subnuclear vacuoles,a“piano keyboard-like”appearance,and clear or eosinophilic cytoplasms.Compared to CGC and CGC expressing primitive phenotypic markers,GAPEP displayed more aggressive clinical features.Molecular analysis showed significant differences in molecular subtypes,TP53 mutation,ERBB2 amplification,ARID1A mutation,MSI status,and CpG island methylator phenotype category.Genomic analysis revealed that TP53 mutations,APC mutations,and ERBB2 amplifications were more frequent in GAPEP.Genes involved in methylation processes were highly upregulated in GAPEP.HAC and GAED shared similar clinicopathological and genetic characteristics.Functional enrichment analysis highlighted the critical role of methylation in the development of GAPEP.CONCLUSION The diversity and aggressiveness of GAPEP are driven by deregulated methylation,necessitating the integration of morphological and immunohistochemical diagnosis.Targeting methylation can provide new therapeutic opportunities for treating this aggressive cancer.
