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Case Reports
. 2023 Mar 30:10:1133335.
doi: 10.3389/fsurg.2023.1133335. eCollection 2023.

Pathologic complete response of hepatoid adenocarcinoma of the stomach after chemo-immunotherapy: A rare case report and literature review

Yunxiang Zhou  1   2   3 , Linping Dong  4   5 , Linyun Dai  6 , Sien Hu  4 , Yongji Sun  4 , Yulian Wu  2   3   4   5 , Tao Pan  1   2   3 , Xiawei Li  2   3   4
Affiliations
Case Reports

Pathologic complete response of hepatoid adenocarcinoma of the stomach after chemo-immunotherapy: A rare case report and literature review

Yunxiang Zhou et al. Front Surg. .

Abstract

Background: Hepatoid adenocarcinoma of the stomach (HAS) is a highly malignant subtype of gastric carcinoma with specific clinicopathological features and extremely poor prognosis. We present an exceedingly rare case of complete response after chemo-immunotherapy.

Case description: A 48-year-old woman with highly elevated serum alpha-fetoprotein (AFP) level was found to have HAS verified by pathological examination based on gastroscopy. Computed tomography scan was done and TNM staging of the tumor was T4aN3aMx. Programmed cell death ligand-1 (PD-L1) immunohistochemistry was performed, revealing a negative PD-L1 expression. Chemo-immunotherapy including oxaliplatin plus S-1 and PD-1 inhibitor terelizumab was given to this patient for 2 months until the serum AFP level decreased from 748.5 to 12.9 ng/mL and the tumor shrank. D2 radical gastrectomy was then performed and histopathology of the resected specimen revealed that the cancerous cells had disappeared. Pathologic complete response (pCR) was achieved and no evidence of recurrence has been found after 1 year of follow-up.

Conclusions: We, for the first time, reported an HAS patient with negative PD-L1 expression who achieved pCR from the combined chemotherapy and immunotherapy. Although no consensus has been reached regarding the therapy, it might provide a potential effective management strategy for HAS patient.

Keywords: PD-1 inhibitor; chemo-immunotherapy; hepatoid adenocarcinoma of the stomach; immune checkpoint inhibitor (ICIs); pathologic complete response; terelizumab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Timeline of the clinical course.
Figure 2
Figure 2
Pathological findings (A) Endoscopic biopsy before chemo-immunotherapy at local hospital (Hematoxylin-eosin staining, magnification ×10); (B) Tumor area and (C) lymph node after 3 courses of chemo-immunotherapy (Hematoxylin-eosin staining, magnification ×10).
Figure 3
Figure 3
Abdominal CT imaging (A) Before chemo-immunotherapy; (B) After 3 courses of chemo-immunotherapy.
See this image and copyright information in PMC

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