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
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.

This page last revised 5.3.2012

©SMUHT/PW Bishop