Alpha-Fetoprotein—Producing Cancer of the Stomach

Alpha-fetoprotein—producing cancer of the stomach

Definition

A gastric adenocarcinoma which produces alpha-fetoprotein. They are defined immunohistochemically by positivity for either alpha-fetoprotein or glypican-3.

Epidemiology

There is a male predominance with a mean age of 61 years1.

Clinical features

Mot but not all patients have a raised serum alpha-fetoprotein, advanced tumours being associated with a higher serum alpha-fetoprotein1.

Radiology

Macroscopic appearances

Early tumours tend to be of mucosal depressed type while more advanced tumours are of fungating type1.

Histopathology

The tumours show various combinations of histological type: common adenocarcinoma type (including poorly/moderately/well-differentiated types); enteroblastic type (composed of cuboidal or columnar cells with clear cytoplasm, resembling the primitive gut); hepatoid type (composed of cells with eosinophilic cytoplasm that proliferated in a sheet or palisading pattern, mimicking the structure of the liver); and yolk sac tumour type (with a network of spindle-shaped tumour cells forming follicles of various sizes)1.

Immunohistochemistry

There were no cases in which the mucosal lesion positive for either alpha-fetoprotein or glypican-3, but the invasive lesion was negative in all components1:

total of 23 tumours, most with multiple components1	histological type	alpha-fetoprotein	glypican-3
mucosal component	common adenocarcinoma	11/211	14/211
mucosal component	enteroblastic	10/171	14/171
invasive component	common adenocarcinoma	10/141	9/141
	enteroblastic	15/181	15/181
	hepatoid	14/161	15/161

Prognosis

These tend to be aggressive tumours.

References

1 Kinjo T, Taniguchi H, Kushima R, Sekine S, Oda I, Saka M, et al. Histologic and immunohistochemical analyses of alpha-fetoprotein--producing cancer of the stomach. Am J Surg Pathol. 2012 Jan;36(1):56-65.