胃肝样腺癌3例及十余年国内文献分析

Hepatoid adenocarcinoma of the stomach: report of 3 cases and review of the literature in recent ten years

目的 :总结本院 3例和国内自 1988年以来报道的共 6 5例胃肝样腺癌 ,旨在提高对该疾病的认识和早期诊断率。方法 :将本院 3例和国内报道的共 6 5例胃肝样腺癌进行分析。结果 :①临床表现 :该病男性多见 (男∶女=6 .2∶1)。首发症状多以上腹部不适等消化道症状为主 ,可伴有剑突下肿块等体征。②诊断 :血清甲胎蛋白 (AFP)含量异常持续增高 ,其阳性检出率达 6 6 .7% (2 2 /33) ;B超或CT检出伴有肝内及周围组织转移者为 2 0 .5 % (9/44) ;该病以胃窦部多见 ,占 6 3.3% (19/30 ) ;胃镜活检并观察其特异的肝细胞样分化病理形态是确诊方法 ;免疫组化染色显示AFP阳性表达率为 94 .5 % (5 2 /5 5 )。③治疗和预后 :仍以手术为主的综合治疗 ,确诊后能行根治术(D2 )仅占 17.9% (5 /2 8) ;该病 1年内死亡率为 5 6 .3% (18/32 )。结论 :胃肝样腺癌是原发于胃粘膜腺体的一种肿瘤 ;AFP的检测有助于胃肝样腺癌的诊断和签别诊断 ,具有肝细胞样分化的病理形态特征是胃肝样腺癌的诊断依据 ,该疾病因常伴肝转移 ,故预后较其他胃腺癌差。

Purpose:To analyze the clinical manifestations, so the diagnosis of hepatoid adenocarcinoma of the stomach (HAS) may be made and treatment instituted as early as possible. Methods:A total of 65 cases of HAS reported in the literature in recent ten years reviewed.Results:①Clinical symptoms and signs: The incidence of HAS in male was higher than that in female (6.2:1).Upper abdominal discomfort and physical signs of mass bclow the sternum were most commonly seen.②Diagnosis: The serum content of AFP were discombfort high level with a positive rate of 66.7%(22/33). The positive rate of AFP expression with immunohistochemical method was 94.5%(52/55).The percentage of liver metastasis detected by US B or CT was 20.5%(9/44) preoperation, and mostly seen at the gastric sinus was ahout 63.3%(19/30). The final diagnosis of HAS depends on gastrocopy and pathology. ③Treatment and Prognosis: The possibility of radical operation(D 2 ) is only 17.9%(5/28). The death ratio within one year was 56.3%(18/32).Conclusions: HAS is primarily a gastric carcinoma. The serum AFP levels are help fulin the diagnosis and differential diagnosis of HAS. The diagnostic evidence of HAS is dependant on its specific forms. The prognosis is often poor because of frequent liver metastasis.