483例胃肝样腺癌患者的临床特征及分析

[目的]探讨胃肝样腺癌(hepatoid adenocarcinoma of the stomach, HAS)患者的年龄、性别、血清甲胎蛋白(AFP)水平、免疫组化、肿瘤分期、治疗方案和生存时间之间的关联。[方法]以“肝样腺癌、胃肝样腺癌、诊治、预后”为检索词,检索2011-01-2021-08期间发表于《PubMed》、《万方数据库》、《中国知网》、《中国期刊数据库》的文章;将来自同一中心的某些病例予以合并,信息不全者予以剔除,归纳总结患者发病年龄、性别、临床表现、影像学、组织病理、免疫组化等相关检查以及诊治、随访情况。[结果]共纳入50篇文章,483例患者。HAS主要以上腹部不适、腹胀、反酸、隐痛、黑便、呕血乏力、消瘦等常见症状就诊。HAS好发胃窦(47.6%)、胃体(27.4%)、贲门(18.0%)、胃底(7.0%);66.1%(272/404)的HAS患者血清AFP阳性、74.0%(309/408)患者AFP蛋白阳性、47.8%(107/224)患者Glycipan-3蛋白阳性、50%(112/224)患者hecapocyle蛋白阳性;107例HAS患者术前行胃镜检查,其中9...     

罕见胃癌亚型胃肝样腺癌1例

本文介绍一种胃癌的特殊亚型:胃肝样腺癌,胃肝样腺癌表达类似与肝细胞癌的病理特点,血清甲胎蛋白高度表达,依据病理学检查肝样腺癌很容易被误诊或者漏诊,胃肝样腺癌发病率极低,相对于其他类型胃癌,胃肝样腺癌发现较晚,易肝转移且预后较差.     

肝肉瘤样癌的临床病理特征

目的:探讨肝肉瘤样癌患者的临床病理学特征、诊断、鉴别诊断、治疗方法和预后.方法:以我院收治的1例肝肉瘤样癌患者为对象,分析其临床表现及诊疗经过,并进行随访,同时对送检标本进行病理学检查,结合有关文献探讨该病的临床病理学特点.结果:肿瘤位于肝脏右后叶,呈浸润性生长.组织学上可见上皮源性肿瘤成分与梭形细胞肉瘤成分同时存在并伴有移行现象;肿瘤中见大片凝固性坏死.免疫组织化学显示肿瘤细胞呈CK(Pan)和EMA强阳性,AFP和Hepar-1呈弱阳性表达,免疫组织化学阴性为:CK7,CK8,CK18,CK(H),CD34,CD117,Dog-1,Actin,SMA, Caldesmon,Desmin,CD10,CD21,CD23,CD35,CD1a,CD2,CD3,CD20,CD45, ALK,CD68,CD163,CD30,CD15,HMB45,S-100.病理诊断:肝肉瘤样癌.结论:肝肉瘤样癌是一种罕见的高度恶性肿瘤,临床与病理上需要与肝癌肉瘤、炎症性滤泡树突细胞肉瘤、炎性肌纤维母细胞肉瘤等相鉴别,预后与肿瘤分期有关.     

胃肝样腺癌的临床与病理关系初步探讨

背景：胃肝样腺癌具有独特的病理形态和临床特点，但临床和病理医师对此尚来引起足够重视。目的：探讨血清甲胎蛋白（APF）阳性的胃肝样腺癌的组织学表现、临床特点及其与预后的关系。方法：2001年1月-2003年12月期间于上海交通大学医学院附属瑞金医院病理证实为胃肝样腺癌者6例，同期随机选取胃低分化腺癌和原发性肝细胞癌（HCC）30例作为埘照，统一行组织学、免疫组织化学检查和临床特点分析。结果：6例胃肝样腺癌患者发病平均年龄66．8岁．发病时血清AFP84-2230ng／ml，6例中2例复发，2例肝转移，平均存活17个月；具有与HCC相似的组织学表现．即多呈实体状，小梁状．大梁状，血管血窦丰富，癌细胞血管淋巴管侵犯多见，免疫组织化学染色AFP均阳性．而HepParl阴性，癌细胞为CD34阳性的血管分割成小梁状。胃低分化腺癌组织学主要表现为实体巢状或弥散分布，免疫组化染色显示癌细胞AFP和HepParl阴性。原发性HCC组织学表现为实体状，小梁状，大梁状以及有丰富的血管血窦．免疫组织化学染色显示癌细胞HepParl阳性。结论：血清AFP阳性的胃肝样腺癌具有发病年龄高、易于复发或肝脏转移、预后差的临床特点。组织学上，胃肝样腺癌与HCC相似，但癌细胞AFP阳性、HepParl阴性可与胃低分化腺癌（AFP和HepParl均阴性）和原发性HCC（HepParl阳性）相鉴别。     

胃肝样与非肝样腺癌的临床对比研究

目的探讨胃肝样与非肝样腺癌的临床病理差异．方法以胃肝样腺癌（２４例）为研究对象，以胃非肝样腺癌（１１２８例）为对照组，由２名以上作者对全部病例的临床病理资料进行回顾性分析．采用放射免疫双抗法和ＡＢＣ免疫组化法检测９５６例（含部分门诊病例）胃癌患者血清ＡＦＰ和４５例石蜡包埋胃癌组织中的ＡＦＰ及ＣＥＡ．对１４０例胃癌患者术后进行了随访．结果对比行卡方检验．结果脉管浸润率、术前肝及其它脏器转移率和术后１年死亡率胃肝样腺癌组和非肝样腺癌组分别为７５００％，２０８３％，８３３％，５０００％及５３３２％，１６０％，０８０％，２８４５％．前组明显高于后组（Ｐ＜００５，Ｐ＜００１）．而发病年龄、性别分布、好发部位及大体类型两组相似．淋巴结转移率无显著性差异（Ｐ＞００５）．结论胃肝样腺癌比一般类型胃癌在生物学行为上更易浸润腺管，肝转移率高，预后差．     

胃肝样腺癌中Glypican-3的表达及临床病理特征的研究

目的 探讨Glypican-3（GPC3）在胃肝样腺癌（HAC）组织中的表达及与临床病理特点和预后之间的关系.方法 回顾性分析2008年～2013年我院确诊的21例胃HAC患者的临床资料,采用免疫组织化学染色的方法检测GPC3、甲胎蛋白（AFP）及肝细胞石蜡单克隆抗体（HepPar-1）在21例胃HAC患者及42例普通型胃腺癌（GC）患者中的表达,分析GPC3与临床病理特点的关系及其与预后的相关性.结果 GPC3、AFP及HepPar-1在胃HAC中的表达明显高于GC,分别为85.7％（18/21）和14.3％（6/42）、48.6％（10/21）和2.4％ （1/42）及57.1％（12/21）和19.0％ （8/42）.在胃HAC患者中,GPC3强阳性比例为66.7％（14/21）,远高于AFP的33.3％（7/21）及HepPar-1的38.1％ （8/21）.GPC3诊断胃HAC的敏感性高于AFP及HepPar-1.GPC3的表达与癌组织脉管侵犯及血清AFP水平升高显著相关（P＜0.05）,与患者的性别、年龄、肿瘤的大小、部位、pTMN分期、是否合并其他类型腺癌、肿瘤分化程度及血清CA199的水平无明显相关（P＞0.05）.Kaplan-Meier分析显示,GPC3在胃HAC中的过表达与手术后的生存时间呈负相关（P＜0.01）.结论 GPC3可用于辅助诊断胃HAC,其过表达是预后不良的相关因素.     

肝上皮样血管内皮瘤的诊断与鉴别诊断

肝上皮样血管内皮瘤是罕见的肝脏恶性肿瘤,来源于血管内皮细胞和梭形细胞,病因尚不明确。临床症状和实验室检查结果均无显著特征性,影像学表现与胆管细胞癌、肝脏转移性癌或其他肝脏少见的恶性肿瘤等也较难鉴别,因此较容易被误诊。明确诊断主要依靠病理学诊断。因属低度恶性肿瘤,治疗效果尚可,肝移植后5年生存率为75%。     

胃肝样腺癌——一类独特的胃癌亚型

1985年Ishikura等发现，有些胃癌标本呈现两种不同的组织学表现，一种为常见的胃腺癌，另一种为肝细胞癌样分化，并将后者命名为胃肝样腺癌(hepatoid adenocarcinoma of the stomach，HAS)。由于病理和临床医师对此型胃癌认识不足，迄今报道不多。胃肝样腺癌除组织形态类似于肝细胞癌外，还具有肝细胞癌的许多生化特征，如产生     

胃肝样腺癌

胃肝样腺癌杨植１赵平ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＳｔｏｍａｃｈｎｅｏｐｌａｓｍｓ／ｐａｔｈｏｌｏｇｙＡｄｅｎｏｃａｒｃｉｎｏｍａ／ｐａｔｈｏｌｏｇｙＡｌｐｈａｆｅｔｏｐｒｏｔｅｉｎｓ／ｂｌｏｏｄ主题词胃肿瘤／病理学腺癌／病理学甲胎蛋白类／血液中国...     

胃肝样腺癌9例并文献复习

目的探讨胃肝样腺癌的病理形态和临床特点。方法回顾性分析2005年1月至2012年1月崇阳县人民医院收治的9例胃肝样腺癌患者的临床资料。结果 9例患者临床表现以上腹部疼痛、腹胀、黑便等消化道症状为主;血清甲胎蛋白(AFP)含量异常持续增高(92.34～1 984.03 ng/ml),阳性率为77.78%(7/9);B超或CT检出伴有肝转移者为33.33%(3/9):该病以胃窦部多发,占66.67%(6/9),病理类型多为溃疡型(77.78%,7/9);胃癌组织内出现肝细胞癌样分化区是其特有的病理形态,9例患者平均存活19个月。结论胃肝样腺癌具有独特的病理形态和临床特点,血清AFP阳性,发病年龄高,易转移,治疗及预后较其他胃腺癌差,应引起临床医师足够重视。     

Clinical outcomes of small cell neuroendocrine carcinoma and adenocarcinoma of the gallbladder

AIM: To compare the demographics and survival rates between gallbladder adenocarcinoma(GB-adenocarcinoma) and small cell neuroendocrine carcinoma of the gallbladder(GB-NEC-SCC).METHODS: From March 2007 to September 2012,patients who underwent resection of tumor stage T2/T3 GB cancer were enrolled for this study.Fortytwo patients were included in this study,including 38 diagnosed with GB-adenocarcinoma and four diagnosed with GB-NEC-SCC.In the GB-adenocarcinoma group,a radical operation was performed in 28 patients,and ten patients underwent simple cholecystectomy.In the GB-NEC-SCC group,a radical operation was performed in three patients,and one patient underwent simple cholecystectomy.Comparative analysis of the two groups was performed,including clinicopathologic features and survival rates.RESULTS: The median age of the patients was 68 y(range: 35-83 years) and females comprised 26/42 of the patients.GB-adenocarcinoma patients were significantly older than GB-NEC-SCC patients(67.89 ± 11.15 vs 55.75 ± 10.31 years; P = 0.029).The median tumor size in GB-adenocarcinoma patients was 2.56 ± 1.75 cm and 3.98 ± 3.74 cm in GB-NEC-SCC patients; however,there was no significant difference between the two groups.For tumors 2 cm,T stage(T2 vs T3),lymphovascular invasion,perineural invasion,lymph node metastasis and lymph node ratio showed no significant differences between the two groups.The overall survival rate of the 42 patients at five years was 77.0%.In the GB-adenocarcinoma group,the overall five-year survival rate was 74.8%,and survival in the GB-NEC-SCC group was 100%,which was not significantly different between the two groups.CONCLUSION: The strategy for treating patients with GB-NEC-SCC should be similar to that used for treating GB-adenocarcinoma,including radical cholecystectomy and liver resection.     

Gastric hepatoid adenocarcinoma: A computed tomography report of six cases

We describe the computed tomography (CT) imaging findings in six cases (five males and one female; age range 61-78 years; mean age 67.3 years) with histologically proven hepatoid adenocarcinoma of the stomach (HAS). Five of the six patients had elevated serum alpha-fetoprotein levels. The most common type of gross appearance HAS on CT is a polypoid mass (83%, 5/6). The most common contrast enhancement pattern was heterogeneous. All six patients had a regional lymphadenopathy larger than 6 mm in its short axis. Liver metastases (n = 3) were noted. Venous tumor thrombosis was identified in the portal vein (n = 2) of the regions near primary gastric tumors or metastatic masses. Our findings suggest in an elderly, male patients with a large heterogeneous enhancement tumor, the presence of distant metastases, regional lymphadenopathy and characteristically increased serum alpha-fetoprotein levels indicates a high likelihood of HAS.     

α-Fetoprotein-producing adenocarcinoma of the pancreas presenting focal hepatoid differentiation

Summary We report a rare case of pancreatic carcinoma producing α-fetoprotein (AFP), showing focal hepatoid differentiation in metastatic lymph nodes. A 65-yr-old female was admitted because of abdominal pain. The serum AFP was measured at 16,170 ng/mL. Radiological examinations revealed a mass measuring 6 cm in diameter in the body and tail of the pancreas. A right supraclavicular lymphadenopathy was found and biopsied. Light microscopy showed a tumor consisting of a portion of a hepatoid area and well-differentiated adenocarcinoma, which was suggestive of a hepatoid adenocarcinoma. Immunohistochemical analysis showed that the tumor cells expressed AFP, α₁-antitrypsin (AT) and albumin. Although the pathological diagnosis of the primary pancreatic tumor was not obtained, this appears to be the first case of hepatoid adenocarcinoma of the pancreas.     

Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings

AIM: To evaluate the dynamic computed tomography (CT) findings of liver metastasis from hepatoid adenocarcinoma of the stomach (HAS) and compared them with hepatocellular carcinoma (HCC).METHODS: Between January 2000 and January 2015, 8 patients with pathologically proven HAS and liver metastases were enrolled. Basic tumor status was evaluated for the primary tumor location and metastatic sites. The CT findings of the liver metastases were analyzed for tumor number and size, presence of tumor necrosis, hemorrhage, venous tumor thrombosis, and dynamic enhancing pattern.RESULTS: The body and antrum were the most common site for primary HAS (n = 7), and observed metastatic sites included the liver (n = 8), lymph nodes (n = 7), peritoneum (n = 4), and lung (n = 2). Most of the liver metastases exhibited tumor necrosis regardless of tumor size. By contrast, tumor hemorrhage was observed only in liver lesions larger than 5 cm (n = 4). Three patterns of venous tumor thrombosis were identified: direct venous invasion by the primary HAS (n = 1), direct venous invasion by the liver metastases (n = 7), and isolated portal vein tumor thrombosis (n = 2). Dynamic CT revealed arterial hyperattenuation and late phase washout in all the liver metastases.CONCLUSION: On dynamic CT, liver metastasis from HAS shared many imaging similarities with HCC. For liver nodules, the presence of isolated portal vein tumor thrombosis and a tendency for tumor necrosis are imaging clues that suggest the diagnosis of HAS.     

狼疮性肾炎患者40例临床病理分析

目的 探讨狼疮性肾炎(LN)的病理类型与临床及实验室检查的关系.方法 对40例狼疮性肾炎患者进行肾活检(其中9例重复肾活检)及病理分型,分析各病理类型的临床特点、实验室检查特点、临床活动性及肾脏病理活动性.结果 所有患者均有病理学异常,Ⅳ型最多见(占42.5%),Ⅳ型LN高血压、肾功能不全及血液系统损害发生率高,血清补体C3下降明显;临床活动性及肾脏病理活动性明显;Ⅳ型、Ⅴ型LN肾病综合征发生率高.结论 狼疮性肾炎的病理类型与临床表现、实验室检查有一定联系;根据狼疮性肾炎的临床表现、实验室检查可以大致推测其病理类型,估计肾损害的严重程度;恰当地治疗可以缓解病情,改善预后.     

胆囊息肉样病变恶性倾向的临床病理分析

目的探讨胆囊息肉样病变恶性倾向的危险因素、超声造影表现及其在鉴别良、恶性息肉样病变中的应用。方法收集356例胆囊息肉样病变的手术病理与术前超声的资料,回顾性分析其临床和病理特征。结果手术病理结果显示,假瘤样息肉是胆囊息肉的最主要病理类型335例(94.1%),其次为良性腺瘤和恶变息肉,分别是12例(3.4%)和9例(2.5%)。在胆囊息肉恶变组中,年龄>50岁居多(占88.9%),其息肉病理类型以乳头状或乳头管状腺瘤为主(OR=17.5,P<0.01)。随着息肉的增大,恶性率逐渐增加。息肉直径≥2cm时,恶性率≥50.0%。结合手术病理结果分析发现,合并胆囊结石是影响胆囊息肉超声诊断的重要因素,彩色多普勒血流显像(CDFI)指标是预测良恶性息肉的独立因素。结论年龄>50岁、胆囊直径增大以及CDFI指标是胆囊息肉恶性倾向的危险因素。     

Cerebral metastasis from hepatoid adenocarcinoma of the stomach

We first report a rare case of metastasis from gastric hepatoid adenocarcinoma （HAC） to cerebral parenchyma, in a 50-year-old Chinese patient. He complained of a one-month history of a paroxysm of headache in the left temple and pars parietalis accompanied with binocular caligation caligo, insensible feeling of limbs and transient anepia. Magnetic resonance （MR） imaging revealed a spherical occupying lesion in the left posterior-temple lobe which was clinically diagnosed as a metastatic tumor. Three years ago, the patient accepted total gastrectomy as he was pathologically diagnosed at gastroscopy having an adenocarcinoma. Eight months after gastrectomy, the occupying lesion in liver was detected by ultrasound and CT, and he accepted transcatheter arterial embolization. Before operation of the brain metastasis, no obvious abnormality was found in liver by ultrasound. Histopathological characteristics of the brain tumor were identical to those of stomach tumor. The growth pattern of both tumors showed solid cell nests. The tumor cells were polygonal, and had abundant eosinophilic cytoplasm and round nuclei with obvious nucleoli. Sinusoid-like blood spaces were located between nodular tumor cells. Immunohistochemistrystained tumor cells were positive for AFP and negative for Hep-Par-1. According to these histopathological findings, both tumors were diagnosed as HAC and metastatic HAC. The patient remained alive 16 mo after tumorectomy of the cerebral metastasis. The differential diagnosis of brain metastasis from metastatic tumors should use a panel of antibodies to avoid confusing with the brain metastasis of hepatocellular carcinoma （HCC）. This paper describes this rare case of metastasis from gastric hepatoid adenocarcinoma to cerebral parenchyma, and provides a review of the literature concerning its histopathological and immunohistochemical characteristics.     

原发性结节肿块型肺黏液腺癌的CT表现与病理基础

目的分析原发性结节肿块型肺黏液腺癌的CT表现、随访变化，以提高对本病的认识。 方法分析80例经病理证实的原发性结节肿块型肺黏液腺癌患者的病理、临床及影像资料。患者均行胸部CT检查，其中57例患者行胸部CT平扫+增强检查，8例有间隔时间2周以上的随访CT。分析病灶影像学征象及动态CT随访变化。 结果微浸润肺黏液腺癌7例，浸润性肺黏液腺癌73例。单发病灶78例，多原发病灶2例。混杂磨玻璃结节20例，实性病灶60例。69例(86.2%)位于胸膜下，49例(61.2%)位于肺下叶。占比50%以上的征象有：类圆形46例、瘤肺界面清楚毛糙45例，分叶征70例、磨玻璃征43例。平扫病灶密度均低于肌肉，轻度强化19例，中度强化30例，明显强化8例，17例病灶内可见无强化的液性区域，血管造影征15例。CT动态随访变化多样，可短期保持稳定或迅速增长，或短期内实性成分减少而磨玻璃成分增多，或长期保持不变或缓慢增长。 结论原发性结节肿块型肺黏液腺癌好发于双肺下叶及胸膜下，多呈类圆形、瘤肺界面清楚毛糙，多伴有分叶征及磨玻璃征，以轻中度强化为主。CT动态随访变化多样。结合病灶的HRCT征象、CT增强及随访变化对诊断肺黏液腺癌有一定意义。