α-Fetoprotein-Producing Hepatoid Gastric Adenocarcinoma With Osteoclast-Like Giant Cells and Neuroendocrine Differentiation: A Case Study With Molecular Profiling

Int J Surg Pathol. 2015 Oct;23(7):537-41. doi: 10.1177/1066896915586807. Epub 2015 May 25.

Abstract

Here we present the case of a 73-year-old woman with an ulcerated, advanced, hepatoid, and α-fetoprotein-producing poorly differentiated (G3) primary gastric adenocarcinoma pT3 N3a M1 with multinucleated cells and evident neuroendocrine component. This tumor was consistent with giant cell tumor type gastric carcinoma with osteoclast-like giant cells (OGCs). The cancer was HER2 and E-cadherin negative, chromogranin A dispersedly and moderately positive, and strongly α-fetoprotein-positive with evident CK AE1/AE3 immunoreactivity, while OGCs expressed CD68. To provide an insight into the molecular background of this peculiar neoplasm, next-generation sequencing (NGS) was performed to analyze the 50 most frequently mutated oncogenes and tumor suppressors. We detected mutations in the primary tumor in the following genes: KIT, EGFR, PTEN, ATM, and RB1. In the liver metastasis, we revealed mutations in 3 genes: PIK3CA, KIT, and CDKN2A.

Keywords: gastric cancer; immunoprofiling; molecular profiling; osteoclast-like giant cells (OGCs).

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / metabolism*
  • Adenocarcinoma / pathology
  • Aged
  • Antigens, CD / metabolism
  • Antigens, Differentiation, Myelomonocytic / metabolism
  • Biomarkers, Tumor / metabolism
  • Female
  • Giant Cells / metabolism*
  • Giant Cells / pathology
  • Humans
  • Osteoclasts / metabolism
  • Osteoclasts / pathology
  • Stomach Neoplasms / metabolism*
  • Stomach Neoplasms / pathology
  • alpha-Fetoproteins / metabolism*

Substances

  • Antigens, CD
  • Antigens, Differentiation, Myelomonocytic
  • Biomarkers, Tumor
  • CD68 antigen, human
  • alpha-Fetoproteins