胃肝样腺癌的病理及临床特征分析

Clinical and pathological characteristics of hepatoid adenocarcinoma of the stomach

[目的]探讨胃肝样腺癌的病理特征、诊断治疗及预后。[方法]收集2010年1月~2016年7月就诊于西京医院并经病理科诊断为胃肝样腺癌的病例14例,包括患者临床相关症状、实验室检查结果、影像学检查结果、手术情况、术后病理特征及预后并进行回顾性分析。[结果]治疗前14例患者中,血清学AFP检查中3例阳性。CT显示胃壁异常增厚。13例胃癌根治患者的术后临床病理分期为2期2例,3期8例,4期3例。淋巴结转移11例,均可见或经免疫组化染色提示脉管、神经侵犯。病理学特征为可见到肝细胞样分化和腺样2种分化,肝细胞样分化区瘤胞浆内可见嗜酸性玻璃样小体,免疫表型为AFP和(或)Hepatocyte阳性。患者术后随访时间为2~74个月,14例患者中5例死亡,8例生存,1例失访。[结论]HAS患者临床症状无特异性,较普通型胃腺癌预后差,具有特征性的病理学特征和免疫表型。

[Objective]To explore the clinical and pathological characteristics of hepatoid adenocarcinoma of the stomach（HAS）.[Methods]A retrospective analysis was conducted in 14 cases who were diagnosed as HAS in Xijing hospital from January 2010 to July 2016.The associated symptoms of patients,lab results,imaging findings,surgery,postoperative pathological characteristics and prognosis were analyzed.[Results]AFP was positive in 3 cases among the 14 cases before the treatments.CT showed abnormal stomach wall thickening of all cases.13 cases underwent surgery,among whom 2 cases were graded stage 2,8 cases graded stage 3 and 3 cases graded stage 4.Lymph node metastasis was found in 11 cases.Vascular and nerve invasion were found in all cases by IHC.Tumors were consisted with glandular and hepatoid component,and positive with AFP and（or）hepatocyte,and eosinophilic vitreous bodies were found in some cytoplasm of tumor cells.During the 2 to 74 months follow-up,5 patients died,8 cases survived,and 1 case lost followup.[Conclusion]HAS patients were lack of characteristic clinical symptoms,with extremely poorer prognosis than adenocarcinoma.HAS has characteristics of the pathology and the immune phenotype.