Hepatoid esophagogastric adenocarcinoma and tumoral heterogeneity: A case report
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AME Publishing Company
Abstract
Hepatoid adenocarcinoma of the stomach is an uncommon subtype of gastric cancer remarkably similar to hepatocellular carcinoma in histopathological analysis. It is also commonly associated with high serum alfa-fetoprotein and a poorer prognosis, despite the emergence of new therapeutic options. In recent years, next generation sequencing (NGS) technology has made it possible to identify and describe the genes and molecular alterations common to gastric cancer thereby contributing to the advancement of targeted therapies. A 62-year-old patient, with no prior risk factor for hepatocellular carcinoma (HCC), presented to the emergency room with dysphagia for solids, abdominal pain and weight loss of about 3 kilograms over 3 months. Histopathological analysis presented with disparities regarding HER2 and programmed death-ligand 1 (PD-L1) status in the primary and metastatic sites. We describe a case of a de novo metastatic, human epidermal growth factor receptor 2 (HER2) positive esophagogastric junction hepatoid adenocarcinoma. Although this is a rare subgroup of gastric cancer, treatment strategies were based in recent studies in immunotherapy and guided therapy, taking into consideration the molecular findings from the patient’s tumor NGS analysis. Data about HER2 and PDL1 heterogeneity were also reviewed. Despite the aggressiveness and rarity of this histology, the patient had a good response to treatment. © Journal of Gastrointestinal Oncology. All rights reserved.
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Case report, Esophagogastric junction, Hepatoid adenocarcinoma, Heterogeneity, Human epidermal growth factor receptor 2 (her2), Alanine aminotransferase, Aspartate aminotransferase, Bilirubin, Biological marker, Cyclin dependent kinase 4, Docetaxel, Epidermal growth factor receptor 2, Epidermal growth factor receptor 3, Fluorouracil, Folinic acid, Oxaliplatin, Paclitaxel, Programmed death 1 ligand 1, Protein p53, Ramucirumab, Smad4 protein, Transcription factor etv6, Trastuzumab, Abdominal pain, Abdominal radiography, Adult, Alanine aminotransferase blood level, Article, Aspartate aminotransferase blood level, Bilirubin blood level, Body weight loss, Cancer combination chemotherapy, Cancer size, Cell heterogeneity, Clinical article, Colitis, Coronary artery disease, Diabetes mellitus, Disease exacerbation, Drug substitution, Drug tolerability, Drug withdrawal, Dysphagia, Emergency ward, Esophageal adenocarcinoma, Family history, Gastroesophageal junction, Gastrointestinal endoscopy, Gene amplification, Gene deletion, High throughput sequencing, Histopathology, Human, Human tissue, Immunohistochemistry, International normalized ratio, Liver biopsy, Liver cell carcinoma, Liver hilus, Liver metastasis, Liver tumor, Lung cancer, Lymphadenopathy, Maintenance chemotherapy, Male, Medical history, Middle aged, Multiple cycle treatment, Neutropenic enterocolitis, Non melanoma skin cancer, Peripheral neuropathy, Rna splice site, Side effect, Stomach adenocarcinoma, Tumor biopsy, Tumor mutational burden, Whole body ct