A Case of Very Early Recurrence of Early Gastric Adenocarcinoma with Enteroblastic Differentiation

Abstract

This report highlights an unusual case of early gastric cancer presenting with very early recurrence within 6 months after curative surgery. The patient, a 73-year-old man, presented with a 0-IIc type early gastric cancer in the middle part of the body of the stomach, for which robot-assisted distal gastrectomy with D2 lymph node dissection was performed. On pathological examination, tub2=tub1>por, T1b (SM2), Ly1b, V1b, N1, and HER2-negative were found, and the tumor was diagnosed as pT1bN1M0 pStage IB. Postoperatively, no adjuvant chemotherapy was administered, and outpatient follow-up was conducted. However, subsequent computed tomography six months after surgery showed multiple liver metastases. Additional pathological analysis of the surgically resected specimen identified adenocarcinoma cells, partly positive for Glypican3, SALL4, and AFP, with clear vesicles amid tubular adenocarcinoma. The coexistence of enteroblastic differentiation within some conventional adenocarcinoma cells was confirmed. Adenocarcinoma with enteroblastic differentiation is a rare subtype of gastric cancer with a high risk of vascular invasion and rapid recurrence. Diagnosis is challenging, especially in early gastric cancer cases with vascular infiltration or lymph node involvement, emphasizing the importance of detailed pathological examination.