Ewha Med J.  2024 Apr;47(2):e28. 10.12771/emj.2024.e28.

Gastric adenocarcinoma with enteroblastic differentiation in a 67-year-old man in Korea: a case report

• Lee HR
• Kim GH
• Joo DC
• Lee MW
• Lee BE
• Kim KB

• KMID: 2556317
• DOI: http://doi.org/10.12771/emj.2024.e28

Abstract

We report a rare case of gastric adenocarcinoma with enteroblastic differentiation (GAED) that was treated with endoscopic submucosal dissection followed by additional distal gastrectomy with lymph node dissection. A 67-year-old man underwent endoscopic submucosal dissection for a gastric lesion, which was diagnosed as GAED with submucosal and lymphatic invasion. Histologically, GAED is characterized by a tubulopapillary growth pattern and clear cells that resemble those of the primitive fetal gut. Immunohistochemically, GAED variably expresses oncofetal proteins such as glypican-3, alpha-fetoprotein, and spalt-like transcription factor 4. Despite negative margins, additional gastrectomy with lymph node dissection was performed due to submucosal and lymphatic invasion. No residual tumor or metastasis was detected, and the patient remained disease-free for 2 years before dying from causes unrelated to GAED. Given its aggressive nature, frequent lymphovascular invasion, and high metastatic potential, clinicians should recognize the histopathological diagnosis of this rare tumor and its propensity for aggressiveness.

Keyword

Adenocarcinoma; Alpha-fetoproteins; Endoscopic mucosal resection; Gastrectomy; Transcription factor 4

Figure

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  Fig. 1. Endoscopic submucosal dissection for early gastric cancer. (A) Conventional endoscopy and indigo carmine chromoendoscopy reveal a 2-cm slightly depressed lesion with nodular mucosal changes on the anterior wall of the gastric prepylorus. (B) Magnifying endoscopy with narrow-band imaging shows irregular microsurface and microvascular patterns. (C) Marking dots are placed around the lesion. (D) A circumferential incision and submucosal dissection are performed using an insulated-tip knife. (E) The lesion is completely excised. (F) The resected specimen is shown.

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  Fig. 2. Histopathological findings. (A) The tumor exhibits a tubulopapillary growth pattern and submucosal invasion (hematoxylin and eosin [H&E] stain, ×40). (B) Tumor cells display clear cytoplasm and a tubular pattern, indicative of enteroblastic adenocarcinoma (H&E stain, ×200). (C,D) Tumor cells test negative for glypican-3 (C) and alpha-fetoprotein (D) (immunohistochemical stain, ×40).

Reference

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