Sano Tomoya, Toyokawa Takahiro, Yoshii Mami, Miki Yuichiro, Tamura Tatsuro, Lee Shigeru, Maeda Kiyoshi
Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan.
Clin J Gastroenterol. 2025 Feb;18(1):57-61. doi: 10.1007/s12328-024-02064-0. Epub 2024 Nov 19.
Endoscopic resection has been applied as an absolute indication for early gastric cancer showing intramucosal cancer ≤ 2 cm in diameter, differentiated-type adenocarcinoma without ulcerative findings. We describe the case of a 76-year-old man who underwent radical gastrectomy for alpha-fetoprotein-producing gastric cancer, in which the depth of invasion was clinically diagnosed as T1a after lymph node metastases were detected. Upper gastrointestinal endoscopy revealed a type 0-IIc tumor nearly 10 mm in diameter at the antrum. Computed tomography showed a 47-mm nodule along the common hepatic artery and a 22-mm nodule in the infrapyloric area. Both were pathologically confirmed as adenocarcinoma by endoscopic ultrasound-guided aspiration. No evidence of malignancy elsewhere was seen on F-fluorodeoxyglucose positron emission tomography. Serum alpha-fetoprotein level was elevated. Postoperatively, microscopic examination revealed moderately differentiated adenocarcinoma confined to the mucosal layer without lymphovascular involvement. Immunohistochemical examination for alpha-fetoprotein revealed that the metastatic nodes were positive despite the primary tumor being negative. The patient died of exacerbation of myelodysplastic syndrome 5 years 8 months postoperatively with no recurrence. Our experience suggests the need for further studies to validate whether the indications for endoscopic resection can apply to alpha-fetoprotein-producing gastric cancer in the same manner as to conventional gastric cancer.
内镜下切除已被用作早期胃癌的绝对指征，这些早期胃癌表现为直径≤2 cm的黏膜内癌、无溃疡表现的分化型腺癌。我们描述了一例76岁男性患者，其因产生甲胎蛋白的胃癌接受了根治性胃切除术，在检测到淋巴结转移后，临床诊断浸润深度为T1a。上消化道内镜检查显示胃窦部有一个直径近10 mm的0-IIc型肿瘤。计算机断层扫描显示沿肝总动脉有一个47 mm的结节，幽门下区域有一个22 mm的结节。通过内镜超声引导下抽吸，两者均经病理证实为腺癌。氟脱氧葡萄糖正电子发射断层扫描未发现其他部位有恶性肿瘤迹象。血清甲胎蛋白水平升高。术后，显微镜检查显示为中分化腺癌，局限于黏膜层，无淋巴管侵犯。甲胎蛋白免疫组化检查显示，尽管原发肿瘤为阴性，但转移淋巴结为阳性。患者术后5年8个月死于骨髓增生异常综合征加重，无复发。我们的经验表明，需要进一步研究以验证内镜下切除的指征是否能以与传统胃癌相同的方式应用于产生甲胎蛋白的胃癌。
