胃肝样腺癌临床特点与诊治分析

胃肝样腺癌（hepatoid adenocarcinoma of the stomach．HAS）是具有腺癌和肝细胞癌样分化特征的原发性胃癌．在肿瘤组织中可检测出甲胎蛋白（AFP）增高,仅1抗胰蛋白酶（α1-AAT）和011抗糜蛋白酶（α1-ACT）阳性。临床以老年男性病人多见,血清AFP可不同程度升高,肝和淋巴结转移率高,预后较普通胃癌差。     

胃肝样腺癌

胃肝样腺癌（hepatoid　adenocarcinoma　of　stomach，HAS）是原发于胃黏膜并且同时具有腺癌和肝细胞癌特征的一种胃癌。病理可同时观察到腺癌区和肝样分化区，因此得名。免疫组织化学染色甲胎蛋白（AFP）、α1抗胰蛋白酶（α1-AAT）、α1抗糜蛋白酶（α1-ACT）阳性，癌胚抗原（CEA）亦可阳性。临床特点以老年男性多见，胃窦部多发，血清AFP可不同程度升高，肝转移率高，分化低，预后明显较普通胃癌差，故作为一种胃癌亚型与一般胃癌区分。     

胃肝样腺癌的临床病理特点及预后分析

目的：探讨胃肝样腺癌的临床特征、病理特点及预后分析。方法：回顾性分析山东大学第二医院2010年6月至2020年6月共21例胃肝样腺癌患者临床病理特点、诊断、治疗方法选择及预后。结果：21例患者以男性为主（19例,90.48%）,中位年龄67岁;好发于胃窦及胃体为主;病变类型分为浸润型、隆起型、溃疡型,以溃疡型为主（10例,47.62%）,伴有远处转移者3例,淋巴结转移者13例,另有4例不易评估;病理类型主要是低分化或中低分化腺癌伴肝样腺癌;治疗前血AFP升高（>20 ng/mL）9例,与组织中AFP表达不完全一致,血AFP表达超过200 ng/mL患者病变组织中均能看到AFP表达;治疗前血CEA升高（>10 ng/mL）3例,在初治后（包括手术和化疗）均能看到AFP及CEA不同程度的下降;根据AJCC第8版肿瘤TNM分期,Ⅰ期3例,Ⅱ期3例,Ⅲ期11例,Ⅳ期4例。Cox回归单因素分析显示是否有远处转移及能否行根治性手术将直接影响患者的总生存期（P<0.05）,在临床上手术仍是治疗HAS的首选方式。肿瘤最大直径及肿瘤组织中是否表达AFP也是不良OS的风险因素,但差异无显...     

甲胎蛋白在胃肝样腺癌中的作用机制及诊断预后研究进展

胃肝样腺癌（HAS）是一种罕见的恶性肿瘤,属于胃癌的特殊亚型,兼具腺癌和肝细胞癌样分化特征,且大部分患者血清甲胎蛋白（AFP）升高。作为肝癌的肿瘤标志物,AFP被广泛应用于临床,但其对于HAS的作用和价值还不明确。为进一步加深AFP在HAS中的认识并了解其临床意义,现就AFP在该病中的作用机制、诊断价值及预后关系等方面进行综述,以帮助临床医师准确诊治。     

胃肝样腺癌三例报告并文献复习

目的 探讨胃肝样腺癌（HAS）的临床病理特点及其诊治,以期指导临床治疗.方法 对华中科技大学同济医学院附属协和医院胃肠外科诊治的3例HAS和2003年至2013年间国内文献报道的94例HAS病例进行汇总分析.结果 97例HAS患者中男性77例,女性20例,年龄33 ～ 84岁,肿瘤原发于胃窦部54例、胃体部12例、胃底贲门部17例、胃体窦部7例、胃底体部5例.患者血清AFP升高者64例,伴淋巴结转移者59例,伴肝转移者54例,伴肺转移者或腹腔转移6例.有效统计本组63例HAS患者的预后,中位生存期为13个月,3年累积生存率为11.1％.结论 胃肝样腺癌是一类特殊而少见类型的胃癌,原发灶多位于胃窦部,血清AFP水平大都升高,易发生肝脏转移及淋巴结转移,预后较差,应予以重视.     

胃肝样腺癌的临床特征与预后

胃肝样腺癌（HAS）是一种具有肝样分化区域的特殊类型胃癌。血清甲胎蛋白（AFP）的产生是HAS一种特征性表现。HAS的发生机制尚不明确,目前相关研究大多为病例报告,缺少大样本病例的研究。HAS的预后很差,肝转移率较高,其生物学行为与普通胃癌有明显区别。无肝转移灶时,胃癌根治术是主要的治疗手段,但目前对于肝转移灶的治疗方案尚无一致结论,血清AFP检测对此类肿瘤的早发现、早诊断以及对患者疗效监控、预测肿瘤的复发与转移均有重要临床意义。     

胃肝样腺癌的临床病理分析

目的 探讨胃肝样腺癌的病理组织学特点、生物学行为及临床诊断和治疗。方法 分析经手术及病理证实的胃肝样腺癌20例，其中14例行根治性胃大部切除术，3例行全胃切除术，3例因伴肝转移而行全胃切除术加肝转移灶切除术。结果 光镜下观察本组最具特征的组织学表现为玻璃样小体、广泛性侵犯静脉；免疫组化甲胎蛋白、α-胰蛋白酶、α-糜蛋白酶均呈阳性；电镜下可见癌细胞围成腔样，类似于毛细管结构，腔面有微绒毛，细胞膜相连处有连接复合体。随访1-5年，死亡12例，其中11例死于胃肝样腺癌广泛转移，1例死于腹腔种植性转移，其余均存活。1年、3年生存率分别为44%（8/18）、17%（3/18）。结论 胃肝样腺癌是原发于胃粘膜并具有腺癌和肝细胞癌特征的一种胃癌，分化差，易发生肝转移，预后不良。     

肉瘤样肝细胞癌:12例临床及病理分析

目的研究肉瘤样肝细胞癌的临床及病理特点，探讨其组织来源及预后。方法结合临床病史及实验室检查，分析12例肉瘤样肝细胞癌的病理及免疫组化。结果11例（91．7％）血液乙肝表面抗原阳性，血清AFP升高9例（75％），10例病理切片中有典型肝细胞癌和肉瘤样组织，另外2例仅有肉瘤样成分，肉瘤样组织可分为梭形细胞、多形细胞及巨细胞三部分。肉瘤样组织中免疫组化标记Vimentin阳性12例（100％）、Hepa阳性7例（58．3％）、AFP阳性4例（33．3％）、AE1／AE3阳性4例（33．3％）。结论肉瘤样肝细胞癌是一种特殊类型的肝细胞癌，在我国同样与乙肝病毒密切相关，尽管本质上是上皮性癌，但其也有部分肉瘤的特性，如体积大，易侵犯肝包膜及周围组织，预后较若。     

胃肝样腺癌的MDT讨论

目的讨论胃肝样腺癌的临床表现、诊断和治疗。方法对四川大学华西医院于2017年10月收治的1例胃肝样腺癌患者在术前所进行的MDT(multi-disciplinary team)讨论进行总结,并复习文献,分析胃肝样腺癌的临床病理学特点。结果胃肝样腺癌的临床特点是常伴有早期肝转移和甲胎蛋白(AFP)明显升高,易误诊为原发性肝细胞癌。其病理组织学特点是,形态上具有肝癌样分化和腺癌样分化两种结构。结论胃肝样腺癌是胃腺癌的特殊类型,根治性手术是其主要治疗手段,但预后较差。     

胃黏膜活检诊断高级别上皮内瘤变与手术病理对比分析

目的探讨胃黏膜活组织检查病理诊断高级别上皮内瘤变（IN）患者胃镜所见及与术后病理的关系。方法回顾分析51例经胃镜钳取活组织病理诊断为胃黏膜高级别IN患者的胃镜下表现．并对照分析其中33例接受外科手术切除标本的病理学检查结果。结果胃镜下有29例（56．9％）的病灶分布在胃窦部,11例（21．6％）在胃体,1例（2．0％）广泛累及胃窦胃体,其余10例分别在胃角和胃底：43例（84．3％）的浅表病灶形似早期胃癌样表现,另有8例（15．7％）的病灶形似进展期胃癌样。接受手术治疗的33例患者中,13例（39．4％）术后病理证实维持高级别IN的诊断,胃镜下病灶形态均为浅表病变,大小均不足20mm;其余20例（60．6％）术后则诊断为胃癌,其中早期胃癌14例．进展期胃癌6例。结论胃镜下胃黏膜活检诊断高级别IN的患者存在胃癌的概率高,应积极随访甚至手术干预。     

Hepatoid adenocarcinoma of the stomach. A case report

Hepatoid adenocarcinoma of the stomach is a very rare tumor with a poor prognosis. Lymph nodes involvement and/or liver metastases are frequently observed. Diagnosis should be pointed out if elevated serum level of alpha-fetoprotein (AFP) is detected with gastric tumor. Histologically, the tumor is an adenocarcinoma of intestinal type including foci of hepato?d differenciation. Immunohistochemistry is positive for alpha-1-antitrypsin and alpha-1-antichymotripsin, and for AFP. We report a case of a 66 year-old man presenting an advanced stage of hepatoid adenocarcinoma of the stomach, treated by gastrectomy followed by chemotherapy. The patient died four months after the surgery because of progressing liver metastatic disease.     

Metastatic splenic α-fetoprotein-producing adenocarcinoma: report of a case

Solitary carcinomatous metastases to the spleen are rare, and the presence of solitary splenic metastasis of hepatoid adenocarcinomas (HAC) has not yet been reported. We herein present the case of a 54-year-old male patient who developed a metastatic tumor to the spleen with enhanced levels of serum α-fetoprotein and carcinoembryonic antigen (CEA). The patient underwent a gastrectomy due to adenocarcinoma of the stomach 5 years previously. The tumor was diagnosed on the grounds of histopathology and immunohistochemical staining after splenectomy. The pathology slides showed both adenocarcinoma and hepatoid structures. α-Fetoprotein antibody staining was positive in the tumor, suggesting hepatoid characteristics. After the operation, the patient recovered well and had no signs of recurrence at a follow-up examination after 9 months. Together with this case, several aspects of the disease are discussed after a review of the current literature.     

Oncocytic adenocarcinoma of the stomach: parietal cell carcinoma

We report 10 cases of an unusual type of gastric adenocarcinoma that occurred in elderly patients 58-81 years of age. Histologically, the tumors were well to moderately differentiated tubular adenocarcinomas with very eosinophilic, finely granular cytoplasm. Immunohistochemical stains for antimitochondrial antibody were strongly positive. Ultrastructurally, the tumor cells had numerous mitochondria in their cytoplasm and occasional intracytoplasmic lumina with associated long microvilli. These histologic and ultrastructural features are similar to those of parietal cells in normal gastric fundic mucosa, but immunohistochemical staining of the tumors using four different antiparietal cell antibodies (anti-H(+)-K(+)-adenosine triphosphatase antibodies) was negative in all cases. Therefore, we think that these tumors were not parietal cell carcinomas but could be termed oncocytic adenocarcinomas, or adenocarcinomas with oncocytic differentiation. Previously reported cases of parietal cell carcinoma have been said to have a favorable prognosis, but it will be necessary to study a larger number of cases to determine the prognosis of oncocytic adenocarcinoma.     

Adenocarcinomas of the distal esophagus and "gastric cardia" are predominantly esophageal carcinomas

BACKGROUND: Adenocarcinoma of the distal esophagus and gastric cardia are defined by the relationship of its epicenter to the gastro-esophageal junction, which is presently defined as the end of the tubular esophagus. We have recently suggested that the true gastro-esophageal junction is best defined by the proximal limit of gastric oxyntic mucosa. AIM: To reclassify adenocarcinomas of this region by the relationship of the tumor to the proximal limit of gastric oxyntic mucosa. METHODS: Seventy-four patients who had esophago-gastrectomy for adenocarcinomas in this region were classified as adenocarcinoma of distal esophagus (38 patients) and gastric cardia (36 patients) by present criteria. The epithelial type at the epicenter and distal edge of these tumors was assessed. RESULTS: The epicenter of the tumor in 64 patients with noncircumferential tumors had squamous (5 cases), cardiac (21 cases), oxynto-cardiac (4 cases), and intestinal (Barrett-type) (34 cases) epithelia. None had gastric oxyntic mucosa. Of the 10 patients with circumferential tumors, 7 had cardiac or oxynto-cardiac epithelium at the distal tumor edge. CONCLUSIONS: If the gastro-esophageal junction is defined histologically as the proximal limit of oxyntic mucosa, 71/74 patients would be classified as adenocarcinoma of the distal esophagus. The other 3 patients were questionable as to gastric or esophageal origin. We suggest that this reclassification based on the proposed new definition of the gastro-esophageal junction provides an explanation for the epidemiologic relationship that exists between adenocarcinoma of the "gastric cardia" and gastro-esophageal reflux disease.     

Primary squamous cell carcinoma in the gastric remnant

A 67-year-old male developed primary gastric squamous cell carcinoma (SCC) 13 years after undergoing distal gastrectomy for gastric cancer. Gastroscopy revealed a type 2 gastric remnant tumor and tumor biopsies revealed poorly differentiated carcinoma. The patient underwent remnant gastrectomy with lateral segment hepatectomy, splenectomy, partial resection of diaphragm, and distal partial esophagectomy. The histological findings revealed SCC without an adenocarcinoma component in the gastric remnant tumor. The patient died 13 months after surgery due to multiple-organ metastasis of gastric SCC. The post-operative prognosis of gastric SCC cases tends to poorer than that of gastric adenocarcinoma. Early diagnosis is important to improve the prognosis of primary gastric SCC and pathogenetic analysis of gastric SCC may contribute to improving the diagnosis and treatment of carcinogenesis and the prognosis of gastric SCC.     

Distinct Recurrence Pattern and Outcome of Adenocarcinoma of the Gastric Cardia in Comparison with Carcinoma of Other Regions of the Stomach

Background Carcinoma arising in the cardioesophageal junction is a distinct clinical entity compared with tumors located in other regions of the stomach. The prognosis for adenocarcinoma of the upper stomach is considered to be relatively poorer than carcinomas of the more distal stomach. We have therefore investigated patients with carcinoma of the gastric cardia in order to evaluate the underlying cause of this poor prognosis. Materials and Methods Clinicopathologic features and postoperative prognosis of 101 patients with carcinoma of the cardia were evaluated and compared with findings on 1884 patients with tumors in other regions of the stomach. Results Tumors of the cardia had a mean size of 6.8 cm, which was significantly larger than the mean size of 5.9 cm for tumors found in the middle- and lower third of the stomach. The incidence of serosal invasion, lymph node metastasis, and lymphatic and blood vessel invasion was higher in association with adenocarcinoma of the cardia than with adenocarcinoma in remaining parts of the stomach. In the analysis of patients who had undergone curative resection, the 5-year survival rates were 61.6, 79.1, and 82.6% in patients with carcinoma of the cardia, upper one-third, and remaining middle- and lower one-third of the stomach, respectively, and the differences were statistically significant. Multivariate analysis indicated that adenocarcinoma of the gastric cardia is an independent prognostic factor. With regard to the site of recurrence, both lymph node and hematogenous recurrence were observed more frequently in the cardia than in the remaining parts of the stomach. Conclusions Our data indicate that the prognosis of patients with adenocarcinoma of the gastric cardia is extremely poor. To improve their prognosis, new treatments in addition to gastrectomy with extensive lymph node dissection are needed.     

Cytoplasmic CD24 Expression Is a Novel Prognostic Factor in Diffuse-Type Gastric Adenocarcinoma

Background CD24, a mucin like cell surface adhesion molecule and a ligand for P-selectin, has been reported as a prognostic factor in a variety of human cancers. However, the role of CD24 in gastric adenocarcinoma remains largely unknown. Methods The expression pattern of CD24 in 103 gastric adenocarcinomas (31 diffuse type, 60 intestinal type, and 12 mixed type) was analyzed by immunohistochemistry. Results Cytoplasmic CD24 expression occurred in 50% of the gastric adenocarcinoma patients and was associated with high-stage tumor (Stage III–IV, P = .023), serosal invasion (SI, P = .010), lymphovascular invasion (LVI, P = .039), and lower 10-year survival (P = .0238). The CD24 staining pattern was different in intestinal and diffuse-type gastric adenocarcinomas. However, the tumor thrombi in lymphovascular spaces exhibited strong cytoplasmic CD24 expression in both types. Further analysis showed that cytoplasmic CD24 expression was, in fact, correlated with high-stage tumor, SI, LVI, and lower 10-year survival significantly (P = .020, P = .007, P = .018, P = .0285, respectively) in diffuse-type gastric adenocarcinoma. Moreover, multivariate analysis showed that cytoplasmic CD24 expression was an independent risk factor of SI and LVI respectively (P = .0083 and P = .0019), and thus it contributed to high-stage tumor and poor patient survival in diffuse- or mixed-type gastric adenocarcinoma. Conclusions Cytoplasmic expression of CD24 was associated with invasiveness and poorer prognosis and can serve as a novel target for prognostic prediction and adjuvant treatment of patients with diffuse-type gastric adenocarcinoma after tumor resection.     

Gastric Hepatoid Adenocarcinoma

Gastric Hepatoid AdenoCarcinoma (GHAC) is a special type of gastric cancer characterized by morphological features similar to hepatocellular carcinoma (HAC). GHAC has been found in different organs such as the stomach, lung, pancreas, oesophagus, papilla of Vater, colon, kidney, uterus and peritoneum. The diagnosis of GHAC is not dependent on production of AFP, but mainly based on recognition of characteristic histologic features. We report the case of a 72-year-old male patient who underwent a total gastrectomy for a large poorly differentiated gastric tumour. The microscopic examination of the tumour showed an adenocarcinoma with two distinct patterns: that of an adenocarcinoma with glandular differentiation and another with a morphological pattern consisting of polygonal neoplastic cells with abundant eosinophilic cytoplasm, prominent nuclei and high mitotic activity. Immunohistochemical staining revealed positive Hep Par1 and AFP, while CK7 and CK20 were negative, the percentage of hepatoid differentiation being about 60%. On the basis of histological and immunohistochemical findings, the diagnosis of hepatoid gastric adenocarcinoma was established. In general, GHACs have an unfavourable prognosis. The majority have already metastasized by the time of diagnosis, usually to the liver and lymph nodes.