We report a rare case of gastric adenocarcinoma with enteroblastic
differentiation (GAED) that was treated with endoscopic submucosal dissection
followed by additional distal gastrectomy with lymph node dissection. A
67-year-old man underwent endoscopic submucosal dissection for a gastric lesion,
which was diagnosed as GAED with submucosal and lymphatic invasion.
Histologically, GAED is characterized by a tubulopapillary growth pattern and
clear cells that resemble those of the primitive fetal gut.
Immunohistochemically, GAED variably expresses oncofetal proteins such as
glypican-3, alpha-fetoprotein, and spalt-like transcription factor 4. Despite
negative margins, additional gastrectomy with lymph node dissection was
performed due to submucosal and lymphatic invasion. No residual tumor or
metastasis was detected, and the patient remained disease-free for 2 years
before dying from causes unrelated to GAED. Given its aggressive nature,
frequent lymphovascular invasion, and high metastatic potential, clinicians
should recognize the histopathological diagnosis of this rare tumor and its
propensity for aggressiveness.