5例胃肝样腺癌临床病理分析

目的:探讨胃肝样腺癌(HAS)病理学形态、免疫组化和临床特征.方法:对5例手术切除的肝样腺癌做临床病理学研究和免疫组织化学检查.结果:HAS多见于老年男性,肿块多位于胃窦,由肝样腺癌伴或不伴普通腺癌组成,肝样腺癌病理形态与原发性肝细胞癌形态相同.肿瘤易转移,预后差.免疫组织化学AFP、α1-AT、α1-ACT阳性.结论:胃肝样腺癌是原发于胃黏膜的癌,组织形态与肝细胞癌相似,常有血清AFP升高,术后监测血清AFP可以提示肿瘤复发或转移,预后较普通胃腺癌差.     

胃肝样腺癌11例分析

目的探讨胃肝样腺癌(HAS)的临床和病理特点及其诊断和治疗。方法回顾我院11例胃肝样腺癌的临床病理特点及其诊断和治疗。结果 11例肝样腺癌平均59.27岁,其中男性9例;治疗前血清AFP均升高(5/5);病变均为溃疡或溃疡型肿物、低分化或中低分化腺癌伴部分肝样腺癌,位于胃窦部2例,胃体部3例,贲门部6例;同时有肝转移者5例(5/11);手术切除者7例,其中3例行根治性手术;7例患者均有淋巴结转移;临床病理分期Ⅲ期2例、Ⅳ期9例;5例手术患者、3例未手术患者行不同疗程的全身化疗±介入化疗;患者总体预后差,死亡4例,其生存期为1～10个月。结论胃肝样腺癌是一类特殊的胃癌,容易发生淋巴结、肝脏转移,临床疗效差,应予以重视。     

１１例胃肝样腺癌患者的病理与临床特征分析

目的：探讨胃肝样腺癌（hepatoid adenocarcinoma of stomach ,HAS）特殊的临床病理特点和预后的关系,以指导临床治疗。方法：回顾性分析我院１１例曾行外科手术切除,术后经病理证实为胃肝样腺癌的患者的多个临床及病理参数。结果：１１例患者中男性７例,女性４例,平均年龄６１.５岁,５例术前已有肝转移,４例术后发生肝转移。发病部位以胃窦部小弯侧多见（５４.５％）,病理类型多为溃疡型（７２.７％）。结论：胃肝样腺癌是原发于胃黏膜腺体的肿瘤,形态上具有肝细胞样分化和腺癌样分化两种结构,因常伴有淋巴转移及肝转移,故预后较普通型胃癌差。     

胃肝样腺癌综述附10例病例分析

胃肝样腺癌(hepatoid adenocarcinoma of the stomach,HAS)是胃癌中一个特殊而少见的类型,发病率为0.38% ～0.73%[1],国内报道的比例较低,可能是缺乏对HAS的进一步认识,忽视了胃癌中具有肝样腺癌分化特征的区域.HAS患者很容易发生肝转移及淋巴结转移,即使发现时分期较早,预后仍较差[2],有着其独特的临床病理特点,现报道文献较少,本文就HAS做一综述并分析我院收治的10例HAS患者的临床病理资料,以期提高对胃肝样腺癌的认识.     

胃肝样腺癌3例及十余年国内文献分析

目的：总结本院3例和国内自1988年以来报道的共65例胃肝样腺癌，旨在提高对该疾病的认识和早期诊断率。方法：将本院3例和国内报道的共65例胃肝样腺癌进行分析。结果：①临床表现：该病男性多见（男：女＝6.2:1)。首发症状多以上腹部不适等消化道症状为主，可伴有剑突下肿块等体征。②诊断：血清甲胎蛋白（AFP)含量异常持续增高，其阳性检出率达66.7%(22/33)；B超或CT检出伴有肝内及周围组织转移者为20.5%（9／44）；该病以胃窦部多见，占63.3%(19/30)；胃镜活检并观察其特异的肝细胞样分化病理形态是确诊方法；免疫组化染色显示AFP阳性表达率为94.5%(52/55)。③治疗和预后：仍以手术为主的综合治疗，确诊后能行根治术（D2)仅占17.9%(5/28)；该病1年内死亡率为56.3%(18/32)。结论：胃肝样腺癌是原发于胃粘膜腺体的一种肿瘤；AFP的检测有助于胃肝样腺癌的诊断和鉴别诊断，具有肝细胞样分化的病理形态特征是胃肝样腺癌的诊断依据，该疾病因常伴肝转移，故预后较其他胃腺癌差。     

AFP阳性胃癌临床分析

对5例AFP阳性胃癌的临床分析，发现胃肝样腺癌多见于中老年患者，其病理类型多数为低分化腺癌，易发生肝和淋巴结转移。术前AFP常规检测可发现此病例。术中行门静脉插管化疗或术后行肝动脉插管介入治疗可能对胃肝样腺癌术后肝转移的预防和治疗有帮助。     

胃肝样腺癌的免疫病理特点分析-附1例病例报告

目的:报道1例伴有神经内分泌特征的胃肝样腺癌,分析其病理组织形态学特点及临床表现。方法:组织形态学结合免疫组织化学研究。结果:本例胃肝样腺癌患者血清AFP水平显著升高;组织学检查显示该肿瘤由类似肝细胞肝癌和腺癌两种病变组成;免疫组织化学染色显示,病变组织表达AFP、PLAP和HCG。结论:伴PLAP和HCG表达的胃肝样腺癌属于未分化癌,未分化癌其组织学特点与胃肝样腺癌相似;胃肝样腺癌伴有PLAP和HCG表达的机制及其生物学行为有待深入研究。     

胃肝样腺癌的免疫病理特点分析——附1例病例报告

目的：报道1例伴有神经内分泌特征的胃肝样腺癌，分析其病理组织形态学特点及临床表现。方法：组织形态学结合免疫组织化学研究。结果：本例胃肝样腺癌患者血清AFP水平显著升高；组织学检查显示该肿瘤由类似肝细胞肝癌和腺癌两种病变组成；免疫组织化学染色显示，病变组织表达AFP、PLAP和HCG。结论：伴PLAP和HCG表达的胃肝样腺癌属于未分化癌，未分化癌其组织学特点与胃肝样腺癌相似；胃肝样腺癌伴有PLAP和HCG表达的机制及其生物学行为有待深入研究。     

胃肝样腺癌的研究进展

原始多潜能干细胞在癌肿瘤发生发展过程中,由于分化的失常,某些胃癌可能向肝细胞、胎儿胃肠方向分化,从而发生肝样癌或肝样腺癌(HAS).HAS的预后非常差.到目前为止还没有看到大规模或长期的临床报道.研究发现预后相关因素为肝转移和淋巴转移.HAS在胃癌基础上对肝癌的完美"模拟"以及嗜血管牛长特性为其易发生肝转移的主要原因.     

AFP阳性胃肝样腺癌15例临床分析

目的:探讨胃肝样腺癌患者的治疗以及预后,同时分析血清甲胎蛋白在诊断胃肝样腺癌及判断预后中的临床意义。方法:分析15例手术病理证实为胃肝样腺癌患者的临床资料。结果:15例患者,生存时间3.1~24个月,平均10.52个月,术前血清AFP浓度范围为25.23~13 500μg/L。结论:胃肝样腺癌AFP 水平波动范围大,血清AFP 升高是胃肝样腺癌重要的临床病理特点,在胃肝样腺癌诊治中具有重要价值,可作为早期诊断的条件之一,同时可以用于监测肿瘤复发与转移。胃肝样腺癌预后极差,合并肝转移或者门静脉癌栓患者建议避免手术治疗。     

Primary Hepatocellular Carcinoma and Hepatoid Adenocarcinoma of the Stomach with Liver Metastasis: An Unusual Association

Alpha-fetoprotein (AFP)-producing hepatoid adenocarcinoma ofthe stomach is a rare and recently discovered entity. We reportan unusual combination of hepatocellular carcinoma and hepatoidadenocarcinoma of the stomach with multiple liver metastases.The patient, a 62-year-old Japanese man, was clinically diagnosedas having hepatocellular carcinoma because of the presence ofliver tumors, a markedly elevated serum AFP level, and a positivehepatitis C virus (HCV) antibody titer. Autopsy revealed multipletumors in the liver; one was a primary hepatocellular carcinomawithout metastasis, and the others were metastases from latenthepatoid adenocarcinoma of the stomach. In the hepatocellularcarcinoma, bile production was observed although the tumor wasimmunohistochemically negative for AFP. On the other hand, boththe primary gastric and metastatic liver hepatoid adenocarcinomaswere positive for AFP. Therefore, hepatoid adenocarcinoma ofthe stomach was responsible for the excessive production ofAFP and was the cause of death.     

胃的肝样腺癌的临床病理分析

目的 研究胃的肝样腺癌（ｈｅｐａｔｏｉｄ ａｄｅｎｏｃａｒｃｉｎｏｍａ ｏｆ ｔｈｅ ｓｔｏｍａｃｈ，ＨＡＳ）和病理形态和临床特点。方法 采用常规ＨＥ染色和免疫组织化学方法对３例胃的肝样腺癌进行研究。结果 ３例ＨＡＳ细胞胞质内均有甲胎蛋白（ＡＦＰ），α－抗胰糜蛋白酶（ＡＣＴ）和α－抗胰蛋白酶（ＡＡＴ）表达。肿瘤的发病部位以胃窦部多见，３例均有局部胃壁脉管浸润和局部淋巴结转移，其中２例有肝转移，分别     

Alpha-fetoprotein producing gastric cancer responding to combined chemotherapy with UFT and adriamycin

A case of AFP producing gastric carcinoma with liver metastasis that showed marked response to combined chemotherapy with UFT and Adriamycin (ADM) is reported. A 61-year-old man was admitted because of lassitude and abdominal fullness. An upper GI series and computed tomography revealed gastric cancer (Borrmann III) and multiple liver tumors. He had a remarkably high serum AFP level (90,000 ng/ml) and a high CEA level (270 ng/ml). The presence of AFP in the tumor cells of the biopsy specimen was proved immunohistochemically. He was treated with 600 mg of UFT orally every day and ADM (10 mg, iv, on days 1-4, repeated every 14 days), resulting in marked regression (PR, partial response) of both the primary tumor and liver metastasis on the 33 rd day after the start of treatment, with decreasing of serum levels of AFP and CEA. The patient has been asymptomatic without evidence of recurrence for a follow-up period of more than three months with continuing treatment in our outpatient clinic. UFT-ADM therapy appears to be useful for gastric cancer.     

A case of AFP-producing gastric cancer after curative operation effectively treated with chemotherapies including hepatic arterial infusion therapy

A 63-year-old woman was admitted complaining of epigastralgia. An endoscopic examination revealed a Borrmann type 2 lesion at the greater curvature of the middle third in the stomach. Abdominal computed tomography detected no liver metastasis. The preoperative serum alpha-phetoprotein (AFP) level was elevated to 242.9 ng/ml. 5-fluorouracil (5-FU) was given 200 mg/day for 26 days orally. Distal gastrectomy with D3+ No. 16b1 lymph node dissection, cholecystectomy and hepatic arterial canulation were performed, and mitomycin C 20 mg was injected intravenously during the operation. Immunohistochemical staining of the specimen for AFP by the SAB method was positive in the cancer lesion. After the operation, FP (cisplatin 100 mg on day 1, 5-FU 750 mg on days 1-3) therapy of one course and intrahepatic arterial infusion therapy using adriamycin 10-20 mg every 2 weeks for 7 months were conducted. Moreover, the patient took UFT 400 mg/day for 26 months orally on an outpatient basis as an adjuvant chemotherapy. The only toxicity was neutropenia (grade 3), but it abated without an interruption in the chemotherapy. The AFP level declined gradually, and returned to the normal range 1 month after surgery. The patient is still alive with no sign of hepatic metastasis or recurrence 7 years and 7 months after the gastrectomy.     

胃肝样腺癌临床病理分析

目的：探讨胃肝样腺癌（hapatoid adenocarcinoma of the stomach, HAS）的病理学特点及临床诊断和治疗。方法：分析201002—01—2011—12-31绍兴市人民医院收治的6例经手术及病理确诊的HAS患者的临床和病理资料。结果：肿瘤位于胃窦部3例,胃体部1例,胃底及贲门部2倒。病理类型,溃疡型3例,蕈伞型1例,弥漫浸润型2例。组织学检查显示,6例均为进展期胃癌,癌组织已侵及肌层或全层。肿瘤分为腺癌区和肝样分化区。6例患者均有淋巴结转移,转移度为28．97％（42／145）。免疫组化检测显示,6例HAS中AFP、ACT和AAT表达均为阳性,4例CEA表达阳性,3例p53表达阳性。随访截止2012—08,6例患者随访时间分别为6、10、15、16、21和29个月,平均随访时间16个月。至随访结束6例患者生存时间分别为6、10、15、16、21和29个月。结论：肝细胞样分化的病理形态特征是胃肝样腺癌的诊断依据,AFP的检测有助于胃肝样腺癌的诊断,常伴有肝和淋巴结转移,预后较其他胃腺癌差。     

A case of postoperative liver metastasis of alpha-fetoprotein producing gastric cancer successfully treated with intrahepatic chemotherapy (adriamycin,cisplatin, irinotecan hydrochloride)

There are only a few reports demonstrating effective regimens for AFP-producing gastric cancer. We report a case of alpha-fetoprotein (AFP)-producing gastric cancer successfully treated with postoperative intrahepatic chemotherapy, together with a review of the literature. A 63-year-old man was diagnosed as having multiple liver metastases 6 months following total gastrectomy for type 2 gastric cancer. Serum AFP level was markedly elevated at 291.4 ng/ml although the level was not determined at the time of gastrectomy. Twenty cycles of intrahepatic arterial infusion with adriamycin, cisplatin, and irinotecan hydrochloride resulted in a 93% decrease in the liver metastases along with normalization of the serum AFP level. These results suggest that this regimen is worth trying for patients with liver metastasis from AFP-producing gastric cancer.     

A case of AFP producing early gastric cancer successfully treated with small dose CDDP and 5-FU (PF) therapy]

A case of AFP producing early gastric cancer successfully treated with a small dose of CDDP and 5-FU therapy administered intermittedly is reported with a review of the literature. A 63-year-old male was admitted to our hospital because of liver metastasis with a high level of serum AFP (185.8 ng/ml) three months after gastrectomy. Systemic chemotherapy was performed twice with a regimen of CDDP 20 mg and 5-FU 750 mg/day in 5 days. After hepatic arterial infusion chemotherapy (HAIC) was performed once, the patient obtained partial response according to CT scan and was discharged. After he underwent HAIC once as an outpatient, liver metastasis completely disappeared 5 months after surgery. He was administered oral 5-FU, 150 mg and Krestin 3.0 g/day and underwent HAIC with CDDP 20 mg and 5-FU 750 mg/day every 2 weeks. After serum AFP level was returned to the normal range 7 months after surgery; HAIC was performed every 4 weeks and continued until one year after surgery. One year and 11 months after surgery, serum AFP remains within the normal limit and there is no evidence of recurrence.     

alpha-fetoprotein producing rectal cancer

A 73-year-old man with a diagnosis of rectal cancer concomitant with multiple liver metastases underwent resection of the primary lesion. The postoperative immunohistochemical study revealed AFP production in the cancer tissue. The initial serum level of AFP after operation was 721 ng/mL. Although the mFOLFOX6 regimen had been started as the first postoperative chemotherapy, the AFP is serum level aggressively elevated to 9, 521 ng/mL and the size of the liver metastases markedly increased. As a second choice of treatment, transarterial chemo-embolization(TACE)using epirubicin hydrochloride and Lipiodol was performed because it was reported to have a high efficacy. After two sessions of the TACE, the serum level of the AFP decreased to 130 ng/mL and the size of the liver metastases reduced by approximately 30%in diameter. The third session of TACE, however, was unable to prevent re-progression of the liver lesion and the development of lung metastases. The patient died of hepatic failure 9 months after operation. It is known that AFP-producing colorectal cancers frequently develop life-limiting liver metastases. As shown in the present case, transcatheter drug delivery exclusively to the lesion in the liver might be the first choice for improving patient survival.