TY - JOUR
T1 - Pediatric Alpha-Fetoprotein-Producing Gastric Cancer Presenting With Dysphagia and Multiple Liver Tumors
AU - Hirano, Takayuki
AU - Hoshi, Reina
AU - Yamaoka, Bin
AU - Ono, Kako
AU - Watanabe, Yosuke
AU - Goto, Shumpei
AU - Hosokawa, Takashi
AU - Kanezawa, Koji
AU - Shimozawa, Katsuyoshi
AU - Arakawa, Ayumu
AU - Uehara, Shuichiro
N1 - Publisher Copyright:
© 2025 The Author(s). Cancer Reports published by Wiley Periodicals LLC.
PY - 2025/9
Y1 - 2025/9
N2 - 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.
AB - 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.
KW - alpha-fetoprotein producing gastric cancer
KW - children
KW - gastrointestinal endoscopy
KW - multiple liver tumors
UR - https://www.scopus.com/pages/publications/105015154544
U2 - 10.1002/cnr2.70348
DO - 10.1002/cnr2.70348
M3 - Article
C2 - 40922714
AN - SCOPUS:105015154544
SN - 2573-8348
VL - 8
JO - Cancer Reports
JF - Cancer Reports
IS - 9
M1 - e70348
ER -
