胃肝样腺癌25例

Gastric hepatoid adenocarcinoma： a report of 25 patients

目的探讨胃肝样腺癌（GHA）的临床病理特点和预后，指导临床诊断和治疗。方法回顾性分析我院2003年1月至2015年12月收治的25例经病理确诊为胃肝样腺癌患者的临床资料。结果25例患者中，男性19例，女性6例，平均年龄61．2岁。临床表现缺乏特异性，病理类型多为溃疡型、分化程度低、伴有广泛脉管癌栓。12例术前肝转移，15例术后肝转移。结论胃肝样腺癌是原发于胃黏膜的恶性肿瘤，是胃腺癌的特殊类型。形态上具有肝癌样分化和腺癌样分化两种结构，临床常伴有早期肝转移和AFP明显升高，易误诊为原发性肝癌。GHA的主要治疗方式为手术切除原发和转移病灶，但预后差。

Objective To study the clinicopathological features and prognosis of Gastric hepatoid adenocarcinoma （GHA） and aims to guide future clinical practice. Method We retrospectively studied the clinical data of 25 patients with pathologically confirmed GHA who were admitted to our hospital from January 2003 to December 2015. Results There were 19 males and 6 females. The average age was 61.2 years. The clinical manifestations were non-specific. Pathologically, majority of GHA presented with ulcerative type, poor differentiation and extensive vascular cancerous embolus. Preoperative liver metastases were found in 12 patients, and postoperative liver metastases in 15 patients. Conclusions GHA is a special primary gastric adenocarcinoma which possesses both hepatocellular carcinoma-like and adenocarcinoma-like histology. GHA is characterized by a significantly elevated serum AFP and early hepatic metastasis. GHA is there- fore often misdiagnosed as primary hepatocellular carcinoma. The main treatment option remains to be surgi- cal resection, and the prognosis is poor.