胃肝样腺癌伴神经内分泌肿瘤13例的临床病理分析  

A study on clinical pathological characteristics and prognosis of 13 gastric hepatoid adenocarcinoma patients with neuroendocrine tumor

作　　者：魏建明[1] 沈艳莹[2] 沈丹平[1] 倪醒之[1] 

机构地区：[1]上海交通大学医学院附属仁济医院普外科,200127 [2]上海交通大学医学院附属仁济医院病理科,200127

出　　处：《中华普通外科杂志》2015年第10期774-776,共3页Chinese Journal of General Surgery

摘　　要：目的探讨胃肝样腺癌伴神经内分泌肿瘤患者的临床病理学特点、免疫组化特征及预后。方法对上海交通大学医学院附属仁济医院2004年6月至2014年6月收治的13例胃肝样腺癌伴神经内分泌肿瘤患者的临床资料进行回顾性分析。结果本组13例胃肝样腺癌伴神经内分泌肿瘤患者中男7例，女6例，中位年龄为62岁。肿瘤位于贲门2例，胃窦8例，胃体3例。肿瘤直径1～19cm。患者中位生存时间为12个月。术前血清AFP升高10例。组织学检查提示肿瘤由肝细胞癌样分化、腺癌分化、神经内分泌分化3种结构构成。免疫组化染色显示肿瘤区域组织AFP、Syn、CgA、Ki-67、P53均呈阳性表达。13例患者均获得随访，因肝转移复发死亡2例．吻合口复发死亡1例，其余患者均无复发并且存活。结论胃肝样腺癌伴神经内分泌肿瘤在结构形态上具有肝细胞样分化、腺癌样分化及神经内分泌分化3种结构，其确诊依赖于免疫组化及病理组织学检查。手术治疗是其主要的治疗方式，患者的预后较差。Objective To explore the clinicopathological and immunohistochemical features, diagnosis and treatment, prognosis of hepatoid adenocareinoma of the stomach with neuroendocrine tumor. AFP, Syn, CgA, Ki-67, P53 were stained by immunohistochemistry and follow-up was conducted by telephone. Methods Hepatoid adenocarcinoma of the stomach with coexisting neuroendocrine tumor was identified in 13 cases from June 2004 to June 2014 in Ren Ji Hospital. Results Among the 13 cases of hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor patients, there were 7 males and 6 females, with an median age of 62 years. Tumors located in the gastric cardia in 2 cases, in the gastric antrum in 8 cases and in the gastric body in 3 cases. Tumor ranged from 1 - 19 cm. The follow-up rate was 100%. The median overall survival rate was 12 months, two patients died of liver metastasis and one patient died of anastomotic recurrence. Serum AFP increased in 10 patients with hepatoid adenoeareinoma of the stomach coexisted with neuroendocrine tumor. The structure consisted of hepatoid cell differentiation and adenocarcinoma differentiation and neuroendocrine differentiation area by histological microscope examination. Immunohistochemical staining showed that tumor regional AFP, Syn, CgA, Ki-67, P53 were positive. Conclusions Hepatoid adenocarcinoma of the stomach coexisting with neuroendoerine tumor is very rare, it is made up of three structures ： hepatoid cell differentiation, adenocarcinoma differentiation and neuroendocrine differentiation area. Diagnosis relies on immunohistochemical and histological examination.

关 键 词：胃肿瘤 神经内分泌瘤 病理学 临床 预后 

分 类 号：R735.2[医药卫生—肿瘤]