胃肝样腺癌临床病理分析

Clinicopathological study of hapatoid adenocarcinoma of stomach

目的:探讨胃肝样腺癌(hapatoid adenocarcinoma of the stomach,HAS)的病理学特点及临床诊断和治疗。方法:分析2010-02-01-2011-12-31绍兴市人民医院收治的6例经手术及病理确诊的HAS患者的临床和病理资料。结果:肿瘤位于胃窦部3例,胃体部1例,胃底及贲门部2例。病理类型,溃疡型3例,蕈伞型1例,弥漫浸润型2例。组织学检查显示,6例均为进展期胃癌,癌组织已侵及肌层或全层。肿瘤分为腺癌区和肝样分化区。6例患者均有淋巴结转移,转移度为28.97%(42/145)。免疫组化检测显示,6例HAS中AFP、ACT和AAT表达均为阳性,4例CEA表达阳性,3例p53表达阳性。随访截止2012-08,6例患者随访时间分别为6、10、15、16、21和29个月,平均随访时间16个月。至随访结束6例患者生存时间分别为6、10、15、16、21和29个月。结论:肝细胞样分化的病理形态特征是胃肝样腺癌的诊断依据,AFP的检测有助于胃肝样腺癌的诊断,常伴有肝和淋巴结转移,预后较其他胃腺癌差。

OBJECTIVE： To investigate the pathological characteristics, hiological behaviours,clinical diagnosis and lreatments of the hapatoid adenocarcinoma of the stomach （HAS）. METHODS： Retrospective analysis of tile pathological and clinical characteristics were sludied in 6 cases in shaoxing People＇s Hospital from Feb. lst,2010 to Dec. 31st, 2011, who had been operated and diagnosed as HAS pathologicly. RESULTS： In the 6 cases they were 3 cases of gastric antrum cancer, 1 case of gastric hody cancer, 2 cases of gastric bottom cancer. Three cases were ulcerative type, 1 case of fungating type,2 cases of diffuse lype. Six cases with lymp node＇s metastasis ,the metastasis ratio was 28.97% （42/45）. Histopatho- logical analysis revealed that the tumor was composed with two pathological changes, which were hepatoid-like foei and adenocarcinomatous. Tumor cells were immunohistochemieally positive for AFP, alphal-antitrypsin （AAT）, and alphal antichymotrypsin（ACT）. All six patients received chemotherapies after operation, but the prognosis was poor. The surviv- al time was from 6 to 29 months. CONCLUSIONS： HAS is primarily a gastric carcinoma. The diagnostic evidence of HAS is de-pending on its histologic structures of hepatoid differentiation. The raised serum level of AFP is helpful to the dianosis of HAS. The prognosis is usually poor due to frequent liver metastasis.