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1
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Tang Y, Li X, Yang Y. Case Report: Second-line favourable effect of pembrolizumab plus chemotherapy in a patient with metastatic hepatoid adenocarcinoma of the stomach. Front Pharmacol 2025; 16:1387661. [PMID: 40235542 PMCID: PMC11996795 DOI: 10.3389/fphar.2025.1387661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/21/2025] [Indexed: 04/17/2025] Open
Abstract
Hepatoid adenocarcinoma of the stomach (HAS) is a rare and aggressive malignancy with poor prognosis. HAS is characterized by both adenocarcinoma and hepatocellular carcinoma like differentiation, which often produces alpha-fetoprotein (AFP) and responds poorly to systemic chemotherapy. Herein we report a case of 62-year-old male diagnosed with liver metastatic HAS, who progressed rapidly after first-line cisplatin + fluorouracil chemotherapy combined with pembrolizumab. However, the patient achieved favourable outcome after second-line oxaliplatin + capecitatine chemotherapy combined with pembrolizumab. This case indicated that the chemotherapy regimen might influence the efficacy of immune check-point inhibiors plus chemotherapy.
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Affiliation(s)
- Yao Tang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofen Li
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Yang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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2
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Petrillo A, Ottaviano M, Pompella L, Giunta EF, Pisapia P, Marte G, Tufo A, Di Lorenzo S, Orefice J, Miceli C, Malapelle U, Daniele B, De Vita F. Rare epithelial gastric cancers: a review of the current treatment knowledge. Ther Adv Med Oncol 2025; 17:17588359241255628. [PMID: 39867743 PMCID: PMC11760139 DOI: 10.1177/17588359241255628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/30/2024] [Indexed: 01/28/2025] Open
Abstract
Gastric cancer (GC), one of the tumours with the highest mortality worldwide, is not a homogeneous disease, showing different features according to location, macroscopic aspect, histotype and molecular alterations. Adenocarcinoma is the most frequent epithelial GC (95%), the remaining 5% comprising rare epithelial tumours with their peculiarities, behaviour and incidence <6 cases/100,000/year. Due to the low number of cases, many aspects must be elucidated in this context. In this narrative review, we highlight the importance of a better understanding of rare GCs to personalize the cures in the light of the precision medicine concept. Our main aim is to translate the scarce evidence from the literature into daily clinical practice, never forgetting that all the clinicians dedicated to rare GCs should encourage such patients' enrolment in clinical trials and promote international collaborations. Hence, we focused on the treatment of the following rare GCs: rare gastric adenocarcinomas (hepatoid adenocarcinoma, medullary carcinoma with lymphoid stroma, Paneth cell carcinoma and Salivary Gland carcinoma); squamous cell carcinoma; adenosquamous carcinoma; neuroendocrine gastric neoplasms; gastroblastoma.
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Affiliation(s)
- Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, Via E. Russo, Naples 80147, Italy
| | - Margaret Ottaviano
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Luca Pompella
- Medical Oncology Unit, Ospedale Ave Gratia Plena, ASL Caserta, San Felice a Cancello, Italy
| | - Emilio Francesco Giunta
- Department of Experimental Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Andrea Tufo
- Surgical Unit, Ospedale del Mare, Naples, Italy
| | - Sara Di Lorenzo
- Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Jessica Orefice
- Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Chiara Miceli
- Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Naples, Italy
| | - Ferdinando De Vita
- Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
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3
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Da X, Juan Z, Zhijun H, Zhongchuan L. Case report: Significant response of alpha-fetoprotein-producing gastric cancer from combined chemotherapy and immunotherapy. Front Immunol 2024; 15:1448875. [PMID: 39530092 PMCID: PMC11551777 DOI: 10.3389/fimmu.2024.1448875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
Background Alpha-fetoprotein-producing gastric cancer (AFPGC) represents a particularly aggressive subtype of gastric carcinoma characterized by elevated rates of vascular invasion, lymphatic dissemination, hepatic metastasis, and an unfavorable clinical outcome. Treatment strategies for AFPGC have historically lacked specificity. Herein, a case is presented involving AFPGC in which the patient exhibited a notable response to combined anti-PD-1 antibody immunotherapy and SOX chemotherapy, potentially achieving a cure. This report marks the first application of this regimen in neoadjuvant therapy for AFP gastric cancer, followed by radical resection and postoperative adjuvant therapy. Case summary A 62-year-old male patient presented with persistent upper abdominal distension and discomfort lasting over 2 months. Initial investigations revealed markedly elevated serum alpha-fetoprotein (AFP) levels, and subsequent pathological examination confirmed the diagnosis of AFPGC via gastroscopy. Due to the patient's condition, surgical resection was initially deemed unfeasible. Therefore, a chemo-immunotherapy regimen consisting of SOX chemotherapy and the PD-1 inhibitor tislelizumab was administered for 3 cycles. Following this, successful laparoscopic radical gastrectomy was performed. The treatment protocol was continued with an additional 3 cycles postoperatively. At the time of this case report, the patient maintained a good quality of life with no evidence of disease recurrence or adverse events. Conclusion The present report highlights a case of AFPGC where significant therapeutic success was achieved through a combined regimen of chemotherapy and immunotherapy, both before and after surgery. The use of anti-PD-1 antibody (tislelizumab) in combination with SOX regimen (S-1 and oxaliplatin) demonstrated effective treatment of AFPGC, potentially offering a curative approach. This approach represents a promising targeted therapy option for patients with AFPGC.
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Affiliation(s)
- Xue Da
- Department of General Surgery, Yantai Yuhuangding Hospital, Shandong, China
| | - Zhang Juan
- Department of Pharmacy, Yantai Yuhuangding Hospital, Shandong, China
| | - Hu Zhijun
- Department of General Surgery, Yantai Yuhuangding Hospital, Shandong, China
| | - Lyu Zhongchuan
- Department of General Surgery, Yantai Yuhuangding Hospital, Shandong, China
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Zhang F, Zhang X, Zhang X, Wang Y, Li T, Guo H, Ding P, Tian Y, Yang P, Li X, Meng N, Guo Z, Zhao Q, Zhang R. Recurrent metastatic patterns and prognosis after radical surgery in patients with alpha-fetoprotein-producing gastric cancer: a retrospective cohort study. Am J Cancer Res 2024; 14:2124-2140. [PMID: 38859826 PMCID: PMC11162674 DOI: 10.62347/iiio8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/24/2024] [Indexed: 06/12/2024] Open
Abstract
Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare and aggressive subtype of gastric cancer associated with poor prognosis. This study aimed to investigate the recurrent metastatic patterns and prognostic factors in AFPGC patients undergoing radical surgical resection. Data from 241 AFPGC patients diagnosed between January 2017 and January 2020 who underwent surgical resection were analyzed across multiple centers. Recurrence patterns, metastatic sites, and survival outcomes were evaluated. Univariate and multivariate analyses were performed to identify risk factors for recurrent metastasis, overall survival (OS), and disease-free survival (DFS). There is an annual increase in the proportion of AFPGC cases, rising from 3.45% in 2017 to 7.88% in 2023. Higher serum AFP level was associated with increased likelihood of lymph node metastasis (P=0.006), deeper invasion depth (P=0.000) and greater tumor diameter (P=0.036). Independent predictors of recurrent metastasis included T4 infiltration, lymph node metastasis, tumor diameter >5 cm, poorly differentiated-undifferentiated pathology, preoperative AFP>1000 ng/mL, and postoperative increasing trend in AFP levels. The 5-year OS and DFS rates were 36.5% and 34.2%, respectively, with poorer survival linked to higher preoperative AFP levels and postoperative increasing trend in AFP level. Independent risk factors for poor OS and DFS included T4 infiltration, lymph node metastasis, poorly differentiated-undifferentiated pathology, preoperative AFP>1000 ng/mL, and postoperative increasing trend in AFP. Serum AFP level can serve as a potential predictive and prognostic biomarker. Identifying independent risk factors informs risk stratification and personalized treatment for AFPGC patients.
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Affiliation(s)
- Fengbin Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Xinran Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Xin Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Yingnan Wang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Tongkun Li
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Honghai Guo
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Ping’an Ding
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Yuan Tian
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Peigang Yang
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Xiaolong Li
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Department of General Surgery, Baoding First Central HospitalBaoding 071000, Hebei, China
| | - Ning Meng
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Department of General Surgery, Shijiazhuang People’s HospitalShijiazhuang 050050, Hebei, China
| | - Zhenjiang Guo
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Department of General Surgery, Hengshui People’s HospitalHengshui 053000, Hebei, China
| | - Qun Zhao
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Ruixing Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
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Jiang H, Fang G, Zhang J. Exceptional Long-Term Survival of a Patient With Hepatoid Adenocarcinoma of the Colon and the Treatment Strategy: A Case Report. Cureus 2024; 16:e55620. [PMID: 38586639 PMCID: PMC10995742 DOI: 10.7759/cureus.55620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Hepatoid adenocarcinoma (HAC) of the colon is a rare type of tumor with hepatocellular differentiation. HAC often produces alpha-fetoprotein (AFP) and metastasizes to lymph nodes and the liver. HAC is usually aggressive with a poor prognosis and has a propensity for intravascular growth and frequent distant metastasis. Because the biology of HAC is not fully understood, there are very limited therapeutic options known to reduce recurrence and improve survival. In addition, because HAC is so rare, it is difficult to acquire data from large randomized clinical trials to guide practice; therefore, case reports can provide valuable information for the treatment of HAC. In this report, we present a case of a 30-year-old male patient with HAC with high AFP levels and liver metastases. The patient underwent hepatic arterial infusion chemotherapy (HAIC) with doxorubicin/oxaliplatin to treat the liver metastasis, and three weeks later, he received radical sigmoid and rectal resection, left liver resection, and ileostomy. Then, the patient received eight cycles of chemotherapy with epirubicin plus folinic acid, fluorouracil, and oxaliplatin (FOLFOX) every three weeks, followed by maintained therapy with capecitabine for 2.5 years without relapse. This case report indicates that, although HAC is usually an aggressive disease with frequent distant metastasis, patients with HAC may still have a good prognosis if treated with appropriate strategy.
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Affiliation(s)
- Honghua Jiang
- Department of Colorectal Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, CHN
| | - Guoping Fang
- Department of Interventional Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, CHN
| | - Jiwei Zhang
- Department of Colorectal Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, CHN
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6
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Fei H, Li ZF, Chen YT, Zhao DB. Hepatoid adenocarcinoma of the stomach with neuroendocrine differentiation: A case report and review of literature. World J Clin Cases 2023; 11:5323-5331. [DOI: 10.12998/wjcc.v11.i22.5323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Both hepatoid adenocarcinoma of the stomach (HAS) and neuroendocrine differentiation (NED) are rare histological subtypes of gastric cancer with unique clinicopathological features and unfavorable outcomes. HAS with NED is even rarer.
CASE SUMMARY Here, we report a 61-year-old man with HAS with NED, as detected by gastric wall thickening by positron emission tomography/computed tomography for a pulmonary nodule. Distal gastrectomy was performed, and pathological examination led to the diagnosis of HAS with NED. However, liver metastases occurred 6 mo later despite adjuvant chemotherapy, and the patient died 27 mo postoperatively.
CONCLUSION We treated a patient with HAS with NED who underwent adjuvant chemotherapy after radical surgery and still developed liver metastases. We first report the detailed processes of the treatment and development of HAS with NED, providing an important reference for the clinical diagnosis and treatment of this condition.
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Affiliation(s)
- He Fei
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ze-Feng Li
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ying-Tai Chen
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dong-Bing Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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7
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Fei H, Li ZF, Chen YT, Zhao DB. Hepatoid adenocarcinoma of the stomach with neuroendocrine differentiation: A case report and review of literature. World J Clin Cases 2023; 11:5329-5337. [PMID: 37621602 PMCID: PMC10445072 DOI: 10.12998/wjcc.v11.i22.5329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Both hepatoid adenocarcinoma of the stomach (HAS) and neuroendocrine differentiation (NED) are rare histological subtypes of gastric cancer with unique clinicopathological features and unfavorable outcomes. HAS with NED is even rarer. CASE SUMMARY Here, we report a 61-year-old man with HAS with NED, as detected by gastric wall thickening by positron emission tomography/computed tomography for a pulmonary nodule. Distal gastrectomy was performed, and pathological examination led to the diagnosis of HAS with NED. However, liver metastases occurred 6 mo later despite adjuvant chemotherapy, and the patient died 27 mo postoperatively. CONCLUSION We treated a patient with HAS with NED who underwent adjuvant chemotherapy after radical surgery and still developed liver metastases. We first report the detailed processes of the treatment and development of HAS with NED, providing an important reference for the clinical diagnosis and treatment of this condition.
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Affiliation(s)
- He Fei
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ze-Feng Li
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ying-Tai Chen
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dong-Bing Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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8
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Zhou Y, Dong L, Dai L, Hu S, Sun Y, Wu Y, Pan T, Li X. Pathologic complete response of hepatoid adenocarcinoma of the stomach after chemo-immunotherapy: A rare case report and literature review. Front Surg 2023; 10:1133335. [PMID: 37065996 PMCID: PMC10098014 DOI: 10.3389/fsurg.2023.1133335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
Background Hepatoid adenocarcinoma of the stomach (HAS) is a highly malignant subtype of gastric carcinoma with specific clinicopathological features and extremely poor prognosis. We present an exceedingly rare case of complete response after chemo-immunotherapy. Case Description A 48-year-old woman with highly elevated serum alpha-fetoprotein (AFP) level was found to have HAS verified by pathological examination based on gastroscopy. Computed tomography scan was done and TNM staging of the tumor was T4aN3aMx. Programmed cell death ligand-1 (PD-L1) immunohistochemistry was performed, revealing a negative PD-L1 expression. Chemo-immunotherapy including oxaliplatin plus S-1 and PD-1 inhibitor terelizumab was given to this patient for 2 months until the serum AFP level decreased from 748.5 to 12.9 ng/mL and the tumor shrank. D2 radical gastrectomy was then performed and histopathology of the resected specimen revealed that the cancerous cells had disappeared. Pathologic complete response (pCR) was achieved and no evidence of recurrence has been found after 1 year of follow-up. Conclusions We, for the first time, reported an HAS patient with negative PD-L1 expression who achieved pCR from the combined chemotherapy and immunotherapy. Although no consensus has been reached regarding the therapy, it might provide a potential effective management strategy for HAS patient.
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Affiliation(s)
- Yunxiang Zhou
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China
| | - Linping Dong
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Linyun Dai
- Department of Surgery, Haiyan People's Hospital, Jiaxing, Zhejiang, China
| | - Sien Hu
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yongji Sun
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yulian Wu
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tao Pan
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China
- Correspondence: Tao Pan Xiawei Li
| | - Xiawei Li
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- Correspondence: Tao Pan Xiawei Li
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Metachronous Liver Metastasis from Alpha-Fetoprotein-Producing Gastric Cancer Successfully Treated with Capecitabine/Oxaliplatin Combination Chemotherapy. Case Rep Surg 2022; 2022:2700394. [PMID: 36051651 PMCID: PMC9427307 DOI: 10.1155/2022/2700394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
A consensus regarding the treatment of recurrent alpha-fetoprotein-producing gastric carcinoma due to its rarity is lacking. We herein describe a case of such a carcinoma that was associated with metachronous liver metastasis. A 73-year-old man was referred for the surgical treatment of a type 2 gastric tumor that extended from the greater curvature of the gastric corpus to the pylorus. As no remote metastases were detected, the patient underwent open total gastrectomy with lymphadenectomy and Roux-en-Y reconstruction. Histopathological examination revealed regional lymph node metastasis and the invasion of the muscularis propria by a moderately differentiated adenocarcinoma. Immunostaining of the primary tumor was positive for alpha-fetoprotein and negative for human epidermal growth factor receptor 2. Serum alpha-fetoprotein levels decreased to within normal limits after eight courses of S-1 monotherapy; however, levels started to increase, and a hypovascular nodule in segment 5/6 of the liver was detected 3.5 years later. Serum alpha-fetoprotein levels returned to the normal range, and the tumor was undetectable after four courses of capecitabine and oxaliplatin therapy. No recurrence was detected at 1.5-year follow-up. This case demonstrates that combined capecitabine and oxaliplatin therapy can successfully treat metachronous liver metastasis from alpha-fetoprotein-producing gastric carcinoma.
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10
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Xia R, Zhou Y, Wang Y, Yuan J, Ma X. Hepatoid Adenocarcinoma of the Stomach: Current Perspectives and New Developments. Front Oncol 2021; 11:633916. [PMID: 33912455 PMCID: PMC8071951 DOI: 10.3389/fonc.2021.633916] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/09/2021] [Indexed: 02/05/2023] Open
Abstract
Hepatoid adenocarcinoma of the stomach (HAS) is a rare malignant tumor, accounting for only 0.17-15% of gastric cancers. Patients are often diagnosed at an advanced disease stage, and their symptoms are similar to conventional gastric cancer (CGC) without specific clinical manifestation. Morphologically, HAC has identical morphology and immunophenotype compared to hepatocellular carcinoma (HCC). This is considered to be an underestimation in diagnosis due to its rare incidence, and no consensus is reached regarding therapy. HAS generally presents with more aggressive behavior and worse prognosis than CGC. The present review summarizes the current literature and relevant knowledge to elaborate on the epidemic, potential mechanisms, clinical manifestations, diagnosis, management, and prognosis to help clinicians accurately diagnose and treat this malignant tumor.
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Affiliation(s)
- Ruolan Xia
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuqing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiaming Yuan
- West China School of Medicine, Sichuan University, Chengdu, China
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Quino-Florentini M, Garcia-Rojas F, Guerra-Canchari P, Cerrillo-Sanchez G. Gastric hepatoid adenocarcinoma with multiple liver metastasis: a case report. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2021; 14:281-285. [PMID: 34221269 PMCID: PMC8245828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022]
Abstract
Hepatoid adenocarcinoma is a poorly differentiated alpha-fetoprotein-producing (AFP) tumor frequently located in the stomach, ovary, and pancreas. Presentation in the stomach has a high mortality rate due to late diagnosis, which offers the patient few therapeutic alternatives. On February 22, 2019, a 44-year-old woman from Lima entered the emergency department for pain in the right hypochondrium for 4 months, weight loss, nausea, and asthenia. On physical examination, hepatomegaly presented with a liver spam of 17 cm. Serology showed severe anemia and AFP of 49,800. The tomography showed multiple hypodense lesions in the liver and the presence of nodes. Endoscopy showed Bormann III gastric malignancy. Gastric biopsy determined undifferentiated epithelial malignancy; the immunohistochemical mark (+) for AFP and PAS Diastase confirmed a hepatoid gastric adenocarcinoma. A rare variant of gastric adenocarcinoma was evident, which often mimics an HCC. In this case, multiple liver metastases were observed that differed from the diagnosis of HCC, so this variant must always be taken into account when a primary gastric tumor presents with hepatic metastases.
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Affiliation(s)
- Mariano Quino-Florentini
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Department of Gastroenterology, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Frank Garcia-Rojas
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Sociedad Científica de San Fernando, Lima, Perú
| | - Pedro Guerra-Canchari
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Sociedad Científica de San Fernando, Lima, Perú
| | - Gustavo Cerrillo-Sanchez
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Department of Pathology, Hospital Nacional Dos de Mayo, Lima, Perú
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