A Case of Multiple Gastric Cancer with Adenocarcinoma Showing Enteroblastic Differentiation

Abstract

We report a case of gastric adenocarcinoma with enteroblastic differentiation (GAED) that occurred with common adenocarcinoma. A 74-year-old man underwent an endoscopic examination for a small amount of hematemesis in a neighboring hospital. The examination showed a 0-IIa lesion in the posterior wall of the cardia (lesion 1), a Type II lesion in the lessor curvature of the corpus (lesion 2), and a 0-IIa lesion in the posterior wall of the corpus (lesion 3). The patient was referred to our department for surgical treatment. Adenocarcinoma was identified on pathological biopsy examinations of the lesion 1 and 2, and adenocarcinoma was suspected for the lesion 3. The patient was diagnosed with multiple gastric cancers, and laparoscopic total gastrectomy was performed. The pathological diagnosis was GAED for lesion 2 and 3 because they were positive for SALL4 and negative for AFP and glypican. GAED occurred with well-differentiated tubular adenocarcinoma (lesion 1). Moreover, lymphatic and vascular invasion and nodal metastases were found.

GAED is very rare, carries an extremely poor prognosis, and the preoperative diagnosis is difficult. When the gastric cancer shows significant lymphatic and vascular invasions and liver metastasis, detailed histopathological studies should be performed.