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Pediatric Alpha-Fetoprotein-Producing Gastric Cancer Presenting With Dysphagia and Multiple Liver Tumors
Takayuki Hirano1, Reina Hoshi1, Bin Yamaoka1
1Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
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.
