胃肝样腺癌1例报告及文献复习  

Hepatoid adenocarcinoma of stomach:A case report and literature review

作　　者：朱琦 李腊梅 蔡艳俊[1] 许芳[1] 牛俊奇[1] 李婉玉[1] ZHU Qi;LI Lamei;CAI Yanjun;XU Fang;NIU Junqi;LI Wanyu(Department of Hepatology,First Hospital,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院肝胆胰内科,吉林长春130021

出　　处：《吉林大学学报（医学版）》2021年第4期1028-1032,共5页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅发展计划项目(20180520116JH);天晴肝病研究基金会项目(TQGB20180160);吉林大学第一医院交叉学科创新项目(JDYYJC006)。

摘　　要：目的:分析胃肝样腺癌(HAS)患者的临床表现、诊断和治疗方法,提高临床医生对该病的认识。方法:收集1例HAS患者的临床资料,并结合相关文献,总结HAS的临床特点、诊断和治疗方法。结果:患者,男性,54岁,因上腹部不适6个月门诊以“胃癌”收入院,胃增强CT检查提示浸润溃疡型胃癌,肝脏多发转移瘤。给予3个疗程新辅助化疗后行胃全切术,胃病理提示“胃腺癌”。后因“肝脏多发转移瘤”转入本科,并行微波射频消融术,术后病理诊断为肝样腺癌,后对胃病理进行免疫组织化学检测确诊为HAS。经治疗后患者生存期仅为9个月。结论:HAS无特异的临床表现,极易误诊为胃腺癌,病理检查和免疫组织化学检测是诊断该病的金标准,手术切除及术后辅助化疗是首选的治疗方式。HAS恶性度高,进展快,应做到早发现和早治疗,以延长患者的生存期。Objective:To analyze the clinical features,diagnosis and treatment methods of hepatoid adenocarcinoma of the stomach(HAS),and to improve the understanding of clinicians to this disease.Methods:The clinical materials of a patient with HAS were collected,and the clinical features,diagnosis and treatment methods were summarized in combination with the relevant literatures. Results:A 54-yearold man had upper abdominal discomfort for 6 months,and was admitted to the hospital because of gastric cancer. The results of contrast enhanced CT of stomach showed infiltrating ulcerative gastric cancer and multiple liver metastases. Three courses of neoadjuvant chemotherapy were given,after that total gastrectomy was performed,and the pathological results indicated gastric adenocarcinoma. Later,the patient was transferred to our department due to multiple metastatic tumors of the liver. The patient underwent microwave radiofrequency ablation, and the pathological diagnosis was hepatoid adenocarcinoma. The pathology of stomach was confirmed by immunohistochemistry as HAS. After treatment,the survival time was only 9 months. Conclusion:HAS has no specific clinical features,and can easily be misdiagnosed as gastric adenocarcinoma. The pathological diagnosis and immunohistonchemistry are the golden standard for the diagnosis of HAS. Surgical excision and postoperative adjuvant chemotherapy are the preferred treatment methods. HAS has high malignancy and rapid progression,the patients with HAS should be given early detection and treatment to prolong their survival time.

关 键 词：胃肝样腺癌 临床病理学 免疫组织化学 计算机断层扫描 射频消融术 

分 类 号：R735.2[医药卫生—肿瘤]