胃原发性绒毛膜癌1例报告及文献复习

Primary Choriocarcinoma of Stomach—A Report of One Case and Review of the Literature

目的胃原发性绒毛膜癌（胃绒癌）很少，国内尚未见报告，故复习文献报告１例。方法５３岁男性，慢性胃炎患者，活检证实为腺癌。术后７７天发生肝转移和腹水死亡，全程６个月。放射免疫检查：血清和尿ＨＣＧβ异常升高。双侧睾丸（包括死后穿刺活检）细查，无异常。标本作组织学和抗ＨＣＧβ抗体免疫组化检查。结果胃小弯有慢性溃疡病，其边缘有癌瘤，该原发癌有绒癌和管状及乳头状腺癌两种成分，腺癌与绒癌和胃粘膜移行。部属淋巴结转移癌全部是绒癌，并有丰富的合体滋养型癌细胞（合体型癌细胞），合体型癌细胞和少数单核滋养型癌细胞抗ＨＣＧβ抗体强阳性，正常胃粘膜腺体和肠化上皮阴性。慢性萎缩性胃炎，肠上皮化生。结论胃原发性绒癌，可能是胃溃疡病癌变。

Objective A case of primary choriocarcinoma of stomach was reported for its rarity and had not been reported in our country.Method A biopsy was made from a male patient,53 years old,with chronic gastritis for getting severe epigastric pain for 3 months,and its pathological examination demonstrated to be an adenocarcinoma.In his serum and urine,the level of human chorionic gonadotropin β(HCG β) was markedly high.77 days after the operation,he died of hepatic metastasis and ascites.The course of the disease was only 6 months.The specimen was examined and immunohistochemical stain was performed using anti HCG β antibody.The related literature was reviewed.Results There was an ulcer with wide fibrous scar with out any carcinomatous cell infiltration in the gastric antrum,the primary carcinoma was located at the edge of chronic ulcer,and both components of choriocarcinoma and tubular papillary adenocarcinoma were found.The transitional lesion was observed between the normal mucous membrane and the carcinomas.The metastatic carcinoma of regional lymph nodes consisited of choriocarcinoma only with many malignant syntrophoblasts.Immunostain showed strong positive for HCG β antibody in malignant syntrophoblasts and a few malignant mononuclear trophoblasts.The normal glands and the epithelial cells of the intestinal metaplasia were negative.There was chronic atrophic gastritis with intestinal epithelial metaplasia.Tumor was not found in the bilateral testes.Conclusions The patient suffered from primary gastric choriocarcinoma.It is possible that the adenocarcinoma in the chronic ulcer of stomach is differentiated into choriocarcinoma.