AFP阳性或阴性的肠道肝样腺癌的病理及临床特征  

Clinical and pathological characteristics of α-fetoprotein positive and negative hepatoid adenocarcinomas of the intestinal tract

作　　者：王志宏[1] 顾立萍[2] 宋锦文[1] 徐红 

机构地区：[1]兰州军区兰州总医院放射介入病区,甘肃省兰州市730050 [2]甘肃省中医药研究院,甘肃省兰州市730050 [3]西京医院病理科,陕西省西安市710032

出　　处：《世界华人消化杂志》2016年第33期4519-4525,共7页World Chinese Journal of Digestology

摘　　要：目的探讨甲胎蛋白(?-fetoprotein,AFP)阳性或阴性的肠道肝样腺癌(hepatoid adenocarcinoma,HAC)的病理特征、诊断治疗及预后.方法收集2010-01/2016-07就诊于西京医院并经病理科确诊为肠道HAC的病例3例,观察记录患者临床相关症状,用电化学发光方法检测血清内肿瘤标志物,影像科检查肝及肺转移情况,手术后标本行常规病理及免疫组织化学验查染色,观察分析病理特征,随访预后并进行回顾性分析.结果术前患者血清学AFP检查,1例呈高浓度阳性,并发生肝转移,1例为阴性,1例未查.3例患者均行肠癌根治术,病理学特征为可见到肝细胞样和腺样两种分化,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.术后临床病理分期为3期2例、4期1例,淋巴结转移2例,均可见或经免疫组织化学染色提示脉管、神经侵犯.患者术后随访时间为2-16 mo,1例死亡,2例生存.结论HAC患者临床症状无特异性,具有特征性的病理学特征和免疫表型,需与肝细胞癌及卵黄囊瘤相鉴别.依靠血清学诊断肠道HAC不可行,但其可能预测肿瘤的生物学行为及转移、复发情况,AFP阴性的患者预后可能要比阳性的好.AIM To explore the clinical and pathological characteristics of α-fetoprotein（AFP） positive and negative hepatoid adenocarcinoma（HAC）of the intestinal tract.METHODS A retrospective analysis was performed of three cases of HAC of the intestinal tract diagnosed at Xijing Hospital from January2010 to July 2016.The clinical symptoms of patients were recorded.Serum tumor markers were tested by electrochemical luminescence.Imaging examinations of liver and lung metastases were performed.Carcinoma tissues were subjected to pathological and immunohistochemical analyses.Postoperative pathological characteristics and prognosis were assessed.RESULTS Before treatment,AFP was highly positive in one case with liver metastasis.All three cases underwent surgical treatment,and pathological staging suggested stage 3 in two cases and stage 4 in one case.Lymph node metastasis was detected in two cases.Vascular and nerve invasion was found in all cases by immunohistochemistry.Tumors consisted of glandular and hepatoid components.Eosinophilic vitreous bodies were found in the cytoplasm of some tumor cells.One patient died,and two cases survived between2 and 16 mo.CONCLUSION HAC patients have no specific symptoms,but have clinicopathological features and immune phenotype.HAC should be differentiated from hepatocellular carcinoma and yolk sac tumors.Although a diagnosis of HAC cannot be achieved by AFP,AFP may be able to help predict the biological behavior,metastasis and recurrences of HAC;AFP negative patients may have better prognosis than positive ones.

关 键 词：肠道 甲胎蛋白 肝样腺癌 病理特征 临床特征 预后 

分 类 号：R735.7[医药卫生—肿瘤]