Three Cases of Gastric Adenocarcinoma with Enteroblstic Differentiation

Abstract

Gastric adenocarcinoma with enteroblastic differentiation (GACED) is a rare histopathological subtype of gastric cancer. It has a tubulopapillary or solid growth pattern of clear cells. In “the Japanese Classification of Gastric Carcinoma”, it is classified into others among special types of gastric carcinoma. The prognosis is said poor due to serious vascular invasion, but its clinical characteristics are still unclear. We report three cases of this tumor performed radical surgery.

Patient 1 was an 80-year-old woman. She was diagnosed with cancer of the gastric cardia and underwent laparoscopic-assisted proximal gastrectomy. The histopathological findings showed Stage IA papillary and tubular adenocarcinoma with clear cytoplasm. Immunostaining was positive for SALL4.

Patient 2 was a 71-year-old man who had a medical history of laparoscopic distal gastrectomy. He was diagnosed with remnant gastric cancer and laparoscopic-assisted total gastrectomy was performed. The histopathological findings showed Stage II A tubular adenocarcinoma with clear cytoplasm. Immunostaining was positive for AFP, SALL4 and Glypican3.

Patient 3 was a 58-year-old man. He was diagnosed with gastric body cancer and underwent laparoscopic distal gastrectomy. The histopathological findings showed Stage IB papillary and tubular adenocarcinoma with clear cytoplasm. Immunostaining was positive for AFP, SALL4 and Glypican3.

The three patients were all diagnosed with GACED due to growth of clear cells and positive responses to oncofetal genes. They are still alive without recurrence of cancer. GACED is a rare condition, and we need to accumulate more cases in order to clarify its clinical features.