胃肝样腺癌脑转移

Hepatoid adenocarcinoma of the stomach with cerebral metastasis

目的介绍大脑实质转移性胃肝样腺癌的组织病理学特点和临床表现。方法对2006年4月20日收治的1例大脑实质转移性胃肝样腺癌患者的临床表现、影像学特点、既往史以及神经病理学结果等进行回顾性分析。结果临床表现为左侧颞顶部阵发性胀痛伴双眼视物不清，短暂性失语1月余；MRI检查显示左侧颞后叶肿物，拟诊为转移性脑肿瘤。3年前因胃贲门部、胃小弯侧溃疡型低分化腺癌行根治性全胃切除术：手术后8个月B超和CT检查发现肝内多发性转移癌，施行肝动脉血管栓塞术。对左侧颞叶转移灶和胃癌手术切除标本存档切片进行组织病理学观察．可见肿瘤呈实性结节状生长、多角形上皮样，有丰富的嗜酸性胞质，细胞核圆，核仁明显，结节间有血窦样裂隙似肝细胞癌；免疫组织化学染色甲胎蛋白阳性，肝细胞石蜡1单克隆抗体阴性，证实二者均为胃肝样腺癌。结论首次报告胃肝样腺癌大脑实质转移病例。提示，对于脑转移癌的组织病理学鉴别诊断需应用成组抗体．避免与肝细胞癌脑转移相混淆；尤其有淋巴结转移、淋巴血管侵袭或转移至其他脏器的患者，应密切注意监测脑转移的发生．

Objective To introduce the pathological characteristics and the clinical manifestation of cerebral parenchymal metastasis in hepatoid adenocarcinoma of the stomach. Methods Retrospective study was performed to analyse the clinical manifestation, imaging characteristics, anamnesis and neuropathological findings of one case with cerebral parenchymal metastasis in hepatoid adenocareinoma of the stomach on April 20 th, 2006. Results The clinical manifestations were paroxysmal distending pain in left temporoparietal region with both eyes visual unclear and transient aphasia over one month. The MRI showed a space occupying lesion in left temporal posterior lobe and the initial diagnosis was cerebral parenchymal metastatic neoplasm. Three years ago, gastrectomy was performed and the diagnosis was cardiac region of stomach and curvature ventricularis minor poorly differentiated ulcerous adenocareinoma. Eight months after gastrectomy, multimetastatic neoplasms were found in liver by ultrasound and CT, and the transcatheter hepatic arterial embolization was performed. The pathological findings of the retained slices from both metastatic and primary cancer showed that the tumor cells presented solid nodulous growth pattern as polygonal epitheloid cells with abundant eosinophilic cytoplasm, round nucleus, clear nucleolus, and blood sinusoid fissure at internodule. The findings resembled hepatocellular carcinoma. Immunohistochemical staining revealed positive for α-fetoprotein and negative for hepatocyte paraffin 1 monoclonal antibody. Both cancers were confirmed as hepatoid adenoearcinoma of the stomach. Condusion We report the first case of hepatoid adenocarcinoma of the stomach with cerebral parenchymal metastasis. It is necessary to use series of antibody tests in the differentiation of metastatic carcinoma with histopathology to avoid the confusion of cerebral metastasis from heptocellular carcinoma. The occurrence of cerebral metastasis should be monitored with close attention to those patients with lymph node metastasis, lymphovascular invasion, or other organs metastasis.