Takayuki Hirano, Reina Hoshi, Bin Yamaoka, Kako Ono, Yosuke Watanabe, Shumpei Goto, Takashi Hosokawa, Koji Kanezawa, Katsuyoshi Shimozawa, Ayumu Arakawa, Shuichiro Uehara
{"title":"以吞咽困难和多发性肝肿瘤为表现的小儿甲胎蛋白生成胃癌","authors":"Takayuki Hirano, Reina Hoshi, Bin Yamaoka, Kako Ono, Yosuke Watanabe, Shumpei Goto, Takashi Hosokawa, Koji Kanezawa, Katsuyoshi Shimozawa, Ayumu Arakawa, Shuichiro Uehara","doi":"10.1002/cnr2.70348","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is resistant to chemotherapy and is associated with poor prognosis. Pediatric gastric cancer has an incidence of 0.02% among gastric cancer patients, with a median survival of 5 months.</p>\n </section>\n \n <section>\n \n <h3> Case</h3>\n \n <p>A 13-year-old boy presented with progressive dysphagia for 2 months, accompanied by loss of appetite and significant weight loss. Liver dysfunction and multiple lesions were observed. Laboratory investigations revealed elevated liver enzymes and tumor markers, including AFP, at 24 502 ng/mL. Computed tomography (CT) showed thickening of the gastric cardia and multiple liver lesions. Upper gastrointestinal endoscopy revealed a type 2 tumor in the cardia. Histopathology confirmed adenocarcinoma, and immunohistochemical staining was positive for AFP, establishing a diagnosis of AFPGC with liver metastases (Stage IV). Given the unresectable and HER2-negative nature of the cancer, chemotherapy with TS-1 and cisplatin was initiated, resulting in a temporary reduction in AFP levels and tumor size. However, disease progression was noted after 3 months, requiring a switch in treatment to ramucirumab, paclitaxel, bleomycin, etoposide, cisplatin, or a study drug. Despite these efforts, the patient succumbed to the disease 16 months after initial treatment.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>AFPGC in children is extremely rare, with few reported cases. The 16-month survival observed in this case exceeds previously reported durations (8 and 4 months). Systematic evaluation of persistent gastrointestinal symptoms enabled earlier diagnosis. Standard adult gastric cancer treatment protocols appeared more effective than AFP-tumor-specific regimens, suggesting they may be optimal for pediatric AFPGC as well. Early diagnosis through detailed history-taking and prompt endoscopic examinations in children with gastrointestinal symptoms may lead to significantly prolonged survival and improved management in this rare malignancy.</p>\n </section>\n </div>","PeriodicalId":9440,"journal":{"name":"Cancer reports","volume":"8 9","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cnr2.70348","citationCount":"0","resultStr":"{\"title\":\"Pediatric Alpha-Fetoprotein-Producing Gastric Cancer Presenting With Dysphagia and Multiple Liver Tumors\",\"authors\":\"Takayuki Hirano, Reina Hoshi, Bin Yamaoka, Kako Ono, Yosuke Watanabe, Shumpei Goto, Takashi Hosokawa, Koji Kanezawa, Katsuyoshi Shimozawa, Ayumu Arakawa, Shuichiro Uehara\",\"doi\":\"10.1002/cnr2.70348\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is resistant to chemotherapy and is associated with poor prognosis. Pediatric gastric cancer has an incidence of 0.02% among gastric cancer patients, with a median survival of 5 months.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Case</h3>\\n \\n <p>A 13-year-old boy presented with progressive dysphagia for 2 months, accompanied by loss of appetite and significant weight loss. Liver dysfunction and multiple lesions were observed. Laboratory investigations revealed elevated liver enzymes and tumor markers, including AFP, at 24 502 ng/mL. Computed tomography (CT) showed thickening of the gastric cardia and multiple liver lesions. Upper gastrointestinal endoscopy revealed a type 2 tumor in the cardia. Histopathology confirmed adenocarcinoma, and immunohistochemical staining was positive for AFP, establishing a diagnosis of AFPGC with liver metastases (Stage IV). Given the unresectable and HER2-negative nature of the cancer, chemotherapy with TS-1 and cisplatin was initiated, resulting in a temporary reduction in AFP levels and tumor size. However, disease progression was noted after 3 months, requiring a switch in treatment to ramucirumab, paclitaxel, bleomycin, etoposide, cisplatin, or a study drug. Despite these efforts, the patient succumbed to the disease 16 months after initial treatment.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>AFPGC in children is extremely rare, with few reported cases. The 16-month survival observed in this case exceeds previously reported durations (8 and 4 months). Systematic evaluation of persistent gastrointestinal symptoms enabled earlier diagnosis. Standard adult gastric cancer treatment protocols appeared more effective than AFP-tumor-specific regimens, suggesting they may be optimal for pediatric AFPGC as well. Early diagnosis through detailed history-taking and prompt endoscopic examinations in children with gastrointestinal symptoms may lead to significantly prolonged survival and improved management in this rare malignancy.</p>\\n </section>\\n </div>\",\"PeriodicalId\":9440,\"journal\":{\"name\":\"Cancer reports\",\"volume\":\"8 9\",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cnr2.70348\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cancer reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/cnr2.70348\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer reports","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cnr2.70348","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Pediatric Alpha-Fetoprotein-Producing Gastric Cancer Presenting With Dysphagia and Multiple Liver Tumors
Background
Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is resistant to chemotherapy and is associated with poor prognosis. Pediatric gastric cancer has an incidence of 0.02% among gastric cancer patients, with a median survival of 5 months.
Case
A 13-year-old boy presented with progressive dysphagia for 2 months, accompanied by loss of appetite and significant weight loss. Liver dysfunction and multiple lesions were observed. Laboratory investigations revealed elevated liver enzymes and tumor markers, including AFP, at 24 502 ng/mL. Computed tomography (CT) showed thickening of the gastric cardia and multiple liver lesions. Upper gastrointestinal endoscopy revealed a type 2 tumor in the cardia. Histopathology confirmed adenocarcinoma, and immunohistochemical staining was positive for AFP, establishing a diagnosis of AFPGC with liver metastases (Stage IV). Given the unresectable and HER2-negative nature of the cancer, chemotherapy with TS-1 and cisplatin was initiated, resulting in a temporary reduction in AFP levels and tumor size. However, disease progression was noted after 3 months, requiring a switch in treatment to ramucirumab, paclitaxel, bleomycin, etoposide, cisplatin, or a study drug. Despite these efforts, the patient succumbed to the disease 16 months after initial treatment.
Conclusion
AFPGC in children is extremely rare, with few reported cases. The 16-month survival observed in this case exceeds previously reported durations (8 and 4 months). Systematic evaluation of persistent gastrointestinal symptoms enabled earlier diagnosis. Standard adult gastric cancer treatment protocols appeared more effective than AFP-tumor-specific regimens, suggesting they may be optimal for pediatric AFPGC as well. Early diagnosis through detailed history-taking and prompt endoscopic examinations in children with gastrointestinal symptoms may lead to significantly prolonged survival and improved management in this rare malignancy.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
