摘要
目的 总结12例胃肝样腺癌(HAS)患者的临床资料,探讨HAS的临床病理特征、临床病理诊断经验,加深对该疾病生物学行为认识度。方法 回顾性分析本院病理科2010~2017年诊断的HAS患者临床病理资料,并结合已有文献及WHO(第5版)消化系统疾病分类对该疾病的归类进行讨论。结果 12例HAS患者中男11例,女1例,平均年龄(55.17±11.65)岁;临床表现为上腹部隐痛、黑便、乏力等;8例患者术前血清AFP升高;11例行根治性胃癌切除术(其中3例行全胃切除术),另1例行姑息性手术;病理组织学呈低分化表现,弥漫或片状排列,肿瘤细胞胞浆红染嗜酸性;常见脉管内癌栓及神经侵犯,多组淋巴结转移;4例患者术前即有肝脏占位;免疫组化:肝细胞分化标记AFP、Hepa、Glypican-3、GS、SALL-4不同程度表达;临床分期:Ⅱ期、Ⅲ期和Ⅳ期分别2例、4例、6例;经2~96个月随访,2例失访,10例在访患者4例死亡,中位生存期42.1个月,1、3、5年生存率分别为80%、80%、70%。结论 HAS临床表现缺乏特异性,常伴血清AFP升高,可表达部分肝细胞癌的标记,诊断需鉴别肝细胞癌转移可能。本病易发生淋巴结及远处转移,临床预后差,手术根治是目前标准的治疗方法。
Objective To summarize clinical data of 12 patients with HAS,and discuss clinic opathological features of HAS,summarize clinicopathological diagnosis experience, and deepen understanding of biological behavior of this disease.Methods From 2010 to 2017,clinic opathological data of patients with HAS diagnosed in our hospital were retrospectively analyzed.Classification of HAS was discussed based on existing literature and the latest WHO classification of Digestive diseases(5th Edition).Results There were 11 males and 1 female with an average age of(55.17±11.65)years.The clinical manifestations included cryptic pain in the upper abdomen, melena and fatigue.Serum AFP was elevated in 8 patients before operation.Eleven patients underwent radical gastrectomy(3 of them underwent total gastrectomy)and one underwent palliative surgery.Histopathology showed low differentiation, diffuse or lamellar arrangement, and eosinophilic red cytoplasm of tumor cells.Vascular tumor thrombus and nerve invasion are common, and multiple groups of lymph node metastasis.Four patients had liver mass before operation.Immunohistochemistry showed that hepatocyte differentiation markers AFP,Hepa, Glypican-3,GS and SALL-4 were expressed in different degrees.Clinical staging included 2 cases of stage II,4 cases of stage III and 6 cases of stage IV,respectively.The median survival time was 42.1 months.The 1,3,and 5-year survival rates were 80%,80%,and 70%,respectively.Conclusion Clinical manifestations of HAS would be lack of specificity, often accompanied by elevated serum AFP,which could be express some markers of hepatocellular carcinoma.Diagnosis would need to distinguish possibility of metastasis of hepatocellular carcinoma. Disease would be prone to lymph node and distant metastasis, clinical prognosis would be poor, radical surgery would be current standard treatment.
作者
雷传芬
黎源
步宏
鲁昌立
Lei Chuanfen;Li Yuan;Bu Hong(Department of Pathology,West China Hospital,Sichuan University,Chengdu,Sichuang 610041;Department of Gastroenterology,Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu,Sichuang 610072,China)
出处
《四川医学》
CAS
2023年第1期40-45,共6页
Sichuan Medical Journal
关键词
胃肝样腺癌
血清AFP
肝细胞癌
预后
hepatoid adenocarcinoma of stomach
serum AFP
hepatocellular carcinoma
prognosis
