Sun Ningbo, Sun Qing, Liu Qun, Zhang Tianxiao, Zhu Qiang, Wang Wei, Cao Ming, Zang Q I
Division of Surgery, Graduate Department, Weifang Medical College, Weifang, Shandong 261031, P.R. China.
Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R China.
Oncol Lett. 2016 May;11(5):3101-3104. doi: 10.3892/ol.2016.4372. Epub 2016 Mar 22.
α-fetoprotein (AFP)-producing gastric carcinoma is a rare type of gastric cancer, and the characteristics have not yet been fully elucidated. The present study reports the case of a patient with this type of gastric cancer. A 66-year-old male was referred to the Department of Gastrointestinal Surgery, Qianfoshan Hospital, Shandong University (Jinan, China) with a 20-day history of retrosternal pain. A computed tomography (CT) scan revealed a thickening of the wall of the cardia and massive lymph node swelling in the region of the lesser curvature of the stomach. A laboratory investigation revealed that the serum AFP levels of the patient were elevated to 46.49 ng/ml (normal level, <12.00 ng/ml), and the serum carcinoembryonic antigen (CEA) levels were 382.22 ng/ml (normal range, <5.00 ng/ml). An endoscopy revealed an elevated tumor and AFP-producing gastric cancer was diagnosed. As the tumor was surgically unresectable, the patient received systemic adjuvant chemotherapy [consisting of 1 cycle of oxaliplatin (150 mg; day 1)-fluorouracil(1.0 g; days 2-6)-calcium folinate (0.3 g; days 2-6), 4 cycles of paclitaxel (80 mg; day 1 and 8, repeated day 21) and capecitabine (1,000 g/m, twice daily; days 1-14, repeated day 21), and 2 cycles of oxaliplatin (130 mg/m; day 1, repeated day 21) and S-1 (100 mg/d; day 1- day 14; repeated day 21)]. During the chemotherapy intermission, the patient experienced partial remission; the serum AFP levels remained between 44.5 and 32.7 ng/ml, and serum CEA levels decreased to a normal level. The CT scan revealed that the enlarged lymph nodes of the patient had decreased in size. During the preoperative examinations, an abdominal CT scan revealed no metastasis to the liver. A radical gastrectomy was performed on October 20, 2014. Additionally, the tumor did not demonstrate the diffusion of AFP. The histopathological examination revealed a poorly differentiated adenocarcinoma, with local and neuroendocrine differentiation and no hepatoid features. According to these histopathological findings, the tumor was diagnosed as AFP-producing non-hepatoid adenocarcinoma of the stomach. The patient was treated with systemic immunity-enhancing therapy and has been free of recurrence for 2 months. The present study describes a rare case of AFP-producing non-hepatoid adenocarcinoma of the stomach, with a review of the literature and an investigation of the clinical features.
甲胎蛋白（AFP）产生型胃癌是一种罕见的胃癌类型，其特征尚未完全阐明。本研究报告了一例该类型胃癌患者的病例。一名66岁男性因胸骨后疼痛20天被转诊至山东大学齐鲁医院（中国济南）胃肠外科。计算机断层扫描（CT）显示贲门壁增厚，胃小弯区域有大量淋巴结肿大。实验室检查显示，患者血清AFP水平升高至46.49 ng/ml（正常水平，<12.00 ng/ml），血清癌胚抗原（CEA）水平为382.22 ng/ml（正常范围，<5.00 ng/ml）。内镜检查发现肿瘤隆起，诊断为AFP产生型胃癌。由于肿瘤无法手术切除，患者接受了全身辅助化疗[包括1个周期的奥沙利铂（150 mg；第1天）-氟尿嘧啶（1.0 g；第2 - 6天）-亚叶酸钙（0.3 g；第2 - 6天），4个周期的紫杉醇（80 mg；第1天和第8天，第21天重复）和卡培他滨（1,000 mg/m²，每日2次；第1 - 14天，第21天重复），以及2个周期的奥沙利铂（130 mg/m²；第1天，第21天重复）和S-1（100 mg/d；第1 - 14天；第21天重复）]。在化疗间歇期，患者病情部分缓解；血清AFP水平维持在44.5至32.7 ng/ml之间，血清CEA水平降至正常水平。CT扫描显示患者肿大的淋巴结尺寸减小。术前检查时，腹部CT扫描显示无肝转移。2014年10月20日进行了根治性胃切除术。此外，肿瘤未显示AFP扩散。组织病理学检查显示为低分化腺癌，伴有局部和神经内分泌分化，无肝样特征。根据这些组织病理学发现，该肿瘤被诊断为胃AFP产生型非肝样腺癌。患者接受了全身免疫增强治疗，已无复发2个月。本研究描述了一例罕见的胃AFP产生型非肝样腺癌病例，并对文献进行了综述，对临床特征进行了研究。
