胃肝样腺癌六例临床误诊原因分析

Clinical and Pathologic Analysis and Cause Analysis of Misdiagnosis of Six Patients with Hepatoid Adenocarcinoma of the Stomach

目的探讨胃肝样腺癌(hepatoid adenocarcinoma of the stomach,HAS)的临床病理特点及误诊原因。方法回顾性分析我院2000年1月—2012年1月收治的6例HAS临床资料。结果本组男4例,女2例;中位年龄59岁。首诊症状:上腹部胀痛不适4例,呕血、黑粪各1例。3例术前检测血清甲胎蛋白(AFP),2例增高。术前仅1例确诊为HAS,5例诊断为普通胃癌。6例术后病理见低分化或中低分化腺癌伴肝癌样分化区。免疫组织化学染色示:腺癌分化区癌胚抗原(CEA)阳性5例,AFP均阴性;肝癌样分化区AFP阳性5例,CEA阳性1例。6例均采取手术为主的综合治疗,中位生存期14个月。结论 HAS具有一定的临床病理特点,预后较差;临床医生应提高对HAS的认识,及时行相关肿瘤标志物检测及广泛活检病理检查,以避免误漏诊。

Objective To explore clinical characteristics,diagnosis and treatment of hepatoid adenocarcinoma of the stomach（HAS）. Methods Six patients with HAS admitted to our hospital during January 2000 and January 2012 were collected,and their clinical data were analyzed retrospectively. Meanwhile,the related literatures were reviewed. Results There were 4 male and 2 female patients with an median age of 59 years. The initial clinical symptoms of HAS were upper abdominal pain and distension（4 cases）,haematemesis and melena（1 case respectively）. Before operation the serum level of alpha fetoprotein（AFP） was detected in 3 patients,and the serum AFP level was elevated in 2 patients. Before operation there was 1 patient confirmed as having HAS,and 5 patients were diagnosed as having ordinary gastric cancer. After operation the pathologic types were poorly or moderately poorly differentiated adenocarcinoma accompanied by hepatoid adenocarcinoma in 6 patients. Immunohistochemistry： the tumor cells of adenocarcinoma differentiation zone were positive for carcinoembryonic antigen（CEA） in 5 patients,and were negative for AFP in all patients. The tumor cells of hepatocellular carcinoma like differentiation zone were positive for AFP in 5 patients,and were positive for CEA in 1 patient. Surgery based combined therapy was applied in 6 patients,but the median survival time was 14 months. Conclusion HAS has certain clinical and pathologic characteristics with poor prognosis. Therefore,clinicians should raise awareness of this disease. Timely detection of tumor markers and biopsy pathological detection are essential to avoid misdiagnosis and missed diagnosis.