胃原发性绒毛膜癌3例临床病理观察

Clinicpathological features of primary gastric choriocarcinoma: report of three cases

目的探讨胃原发性绒毛膜上皮癌(PGC)的临床表现及病理形态学特征。方法对3例PGC患者的临床表现、组织形态学特征及免疫组化特点进行分析,并复习相关文献。结果本组3例PGC的临床表现为胃部巨大溃疡型肿块,并伴有胃周围淋巴结及肝转移;3例患者血清β-HCG均异常升高。主要病理形态学表现为呈片状分布的细胞滋养层细胞及合体滋养层细胞,肿瘤细胞异型性明显,并可见大片坏死及出血。免疫组化:肿瘤细胞CK和HCG(+),CEA和AFP(-),Ki-67阳性指数>80%。结论 PGC是一种罕见的高度恶性肿瘤,其典型的临床表现是胃部肿块和血HCG异常升高,并伴有淋巴结及肝转移。PGC需要与胃低分化腺癌鉴别,其预后极差,中位生存期只有数月。

Objective To study the clinicpathological features of primary gastric choriocarcinoma （PGC）. Methods Three cases of PGC were retrived, and the clinical manifestations, laboratory results and pathological features were analysed. The associated literatures were reviewed as well as the key points of the diagnosis and the differential diagnosis were discussed. Results The major clinical manifestations of PGC were huge ulcerated masses of stomach （3/3） , with metastasis to the lymph nodes around the stomach and the liver （3/3）. And high serum levels of beta-human chorionic gonadotropin （β-hCG） were detected in all 3 cases. Morphologically, the PGCs were consisted of syncytiotrophoblasts and eytotrophoblasts with marked hemorrhage and necrosis, and the syncytiotrophoblastic giant cells were also recognized in the sections. Immunohistochemical staining showed that the tumors were positive for CK and β-hCG, negative for CEA and AFP, and the Ki-67 index was more than 80%. Conclusions PGC is an exceedingly rare high malignant neoplasm. A markedly elevated serum beta human chorionic gonadotrophin （beta HCG） level and a tremendous mass with lymph node and liver metastases are the characteristic features of this tumor. It should be differentiated from poorly differentiated adenocarcinoma of stomach. The prognosis of PGC is very poor, and the median survival is known to be less than several months.