胃肝样腺癌临床及病理特点  

Clinical and Pathologic Features of HAS (a Report of Two Cases)

作　　者：许东辉[1] 江显毅[2] 张思宇[3] 方庆全[2] 陈福真[1] 

机构地区：[1]福建医科大学附属厦门市第一医院血管肝胆胰外科,厦门361003 [2]福建医科大学附属厦门市第一医院病理科,厦门361003 [3]福建医科大学附属厦门市第一医院普外科,厦门361003

出　　处：《中国临床医学》2004年第3期372-373,共2页Chinese Journal of Clinical Medicine

摘　　要：目的 :为提高对胃肝样腺癌的认识。方法 :将本院 2例和国内报告的 97例胃肝样腺癌进行总结分析。结果 :①临床特点 :男性中老年多见。②多发于胃窦。症状无特异性 ,以上腹部闷痛、腹胀、黑便等消化道症状为主。血清AFP阳性率5 9 .8%。③诊断 :钡餐及胃镜可诊断胃癌 ,由于胃镜下所取组织少 ,术前确诊胃肝样腺癌较困难 ,仅占胃癌的 9.3% ,术后病理诊断是关键。④病理组织学上可见肝癌样区及腺癌区。肝癌样区AFP免疫组化染色阳性占 88.7% ,AAT阳性表达占91.7% ,ACT阳性表达占 93.8%。⑤治疗与预后 :以根治手术为主的综合治疗。预后较胃非肝样腺癌差。结论 :胃肝样腺癌与胃非肝样腺癌均为胃上皮肿瘤 ,血清AFP阳性及免疫组化AFP染色阳性 ,有助于诊断胃肝样腺癌。而有肝癌样分化是胃肝样腺癌的主要病理特征 ,也是诊断胃肝样腺癌必不可少的依据。该病易转移至肝脏 ,预后差。Objective: To recognize Hepatoid adenocarcinoma of the stomach (HAS) better. Methods: Summarize and analyze 2 cases of HAS in our hospital and 97 cases reported domestically. Results: ① Clinical features: Occur mainly in middle-older man; ② Located at stomach sinus mostly, no peculiar symptoms. The main digestive symtoms are dull pain in upper abdomen, abdominal distention and stcol like tar. The rate positive of serum AFP was 59.8%;③ Diagnosis: Stomach cancer can be diagnosed by barium meal examination and gastroscopy, but it is difficult to diagnose preoperatively, the preopertive diagnostic rate was 9.3% at stomach cancer. Postoperative pathological diagnose is critical. ④ Pathological tissue slice like liver cancer and stomach cancer could be seen.The positive rate of AFP expression with immunohistochemical method in like liver cancer tissue was 88.7%and ATT was 91.7%,ACT was93.8%. ⑤ Treatment and Prognosis: The treatment method was radical operation, but its prognosis was worse than non-HAS. Conclusion:Both HAS and non-HAS are gastric epithelial carcinoma, the positive of serum AFP and immunohistochemistry AFP help to diagnose HAS. The diagnose of HAS is dependent on pathological features. The prognosis is bad because of frequent liver metastasis.

关 键 词：胃肝样腺癌 病理特点 免疫组化 预后 治疗 

分 类 号：R735.2[医药卫生—肿瘤]