A case of hepatoid adenocarcinoma of the stomach

The patient was a 76-year-old man with no chief complaint. He presented to an internist of our hospital for an evaluation of anemia. An upper gastrointestinal endoscopy revealed a type 2 tumor at the lesser curvature of the gastric body. Although the blood analysis showed a high amount of AFP(2, 328 ng/mL), there was no abnormality found in the liver with a CT scan. The tumor was presumed to be an AFP-producing gastric cancer on the basis of the tumor biopsy. We performed total gastrectomy, splenectomy and cholecystectomy. The tumor cells were positive for AFP by immunohistochemistry. The final diagnosis was hepatoid adenocarcinoma, pT3(SS), INF b, ly1, v2, pN1(3/42), pStage II B. Tumor cells were negative for antihepatocyte antibody and anti-HER2 antibody. The amount of AFP normalized postoperatively. After discharge, he was treated with S-1(80mg/day)orally. He is relapse-free now, 14 months after the operation. Hepatoid adenocarcinoma is an extremely aggressive tumor with a poor prognosis, and effective chemotherapy has still not been established. A larger number of analyses, along with a molecular biological approach, is sure to be helpful for the establishment of an effective treatment for hepatoid adenocarcinoma.     

分泌超高血清AFP胃肝样腺癌1例并文献复习

胃肝样腺癌(Hepatoid adenocarcinoma of the stomach,HAS)属于胃癌中较为罕见的一种病例类型,恶性程度极高,预后差,易发生肝脏及淋巴结转移。本文报道1例近期发生的胃肝样腺癌病例,以期提高临床医师对这类疾病的认识和积累治疗经验。     

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.     

胃肝样腺癌伴肝转移治疗成功1例报告

我们报告一例成功治疗胃肝样腺癌(hepatoid adenocarcinoma of stomach,HAS)伴肝转移的病例,并复习了相关文献。患者男性,60岁,诊断为HAS伴肝转移,血AFP 780ng/ml,行根治性胃大部切除和肝切除术。术后经肝动脉行灌注化疗后,血AFP降至正常。胃的肝样腺癌(HAS)是具有肝细胞样分化和腺癌分化的胃癌,通常可以产生甲胎蛋白(AFP),易早期发生肝脏转移,预后不良,平均生存期<1年。此例病人随访8年,无肿瘤复发迹象。提示对HAS伴肝转移的病人仍有积极治疗的价值。     

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。     

Histogenesis of hepatoid adenocarcinoma of the stomach: molecular evidence of identical origin with coexistent tubular adenocarcinoma

Hepatoid adenocarcinoma of the stomach is a highly malignant neoplasm. Most gastric hepatoid adenocarcinomas coexist with tubular adenocarcinoma. However, the relationship between hepatoid adenocarcinoma and tubular adenocarcinoma is still unclear. In the present study, the characteristics of the coexistent tubular adenocarcinomas were determined by examining their profiles of mucin production. Subsequently, molecular pathological techniques were applied to determine the clonality of 15 mixed hepatoid and tubular adenocarcinomas of the stomach. Mucin analysis suggested that the coexistent tubular adenocarcinomas with hepatoid adenocarcinoma were of the intestinal type. The patterns of chromosome X inactivation were identical between the hepatoid adenocarcinoma component and tubular adenocarcinoma component in all of 3 informative female cases. Mutations in the p53 gene were found in 5 cases. The sequences were identical within both tumor components in all 5 cases. Microsatellite analysis indicated more than 3 common patterns of loss of heterozygosity in 8 cases. These observations strongly suggested that hepatoid adenocarcinomas were of identical origin to coexistent tubular adenocarcinomas.     

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。     

胃肝样腺癌临床病理特征和预后的研究进展

胃肝样腺癌(HAS)是胃癌的一种罕见亚型,与普通胃腺癌比较,HAS在肿瘤标志物、影像学表现、组织病理特征、免疫表型、治疗和预后等方面有独特的特征。HAS同时存在胃腺癌和肝细胞癌特征,常出现误诊和漏诊。了解HAS的临床和病理特征,有助于提高诊断率、降低死亡率,延长患者的生存时间。     

30例胃肝样腺癌患者临床病理特点及预后分析

  目的  研究胃肝样腺癌患者的临床病理特点及预后因素。  方法  回顾性收集2012年8月至2017年6月北京大学肿瘤医院收治的30例胃肝样腺癌患者的临床病理资料并行生存分析。  结果  30例胃肝样腺癌患者初诊时29例伴有周围淋巴结转移,7例伴有远处转移,其中6例伴有肝转移。1年生存率为60%,3年生存率为52%。Cox多因素回归模型分析显示肿瘤标记物CA199升高、淋巴结分期、是否行根治性手术及血清甲胎蛋白（α-fetoprotein,AFP）免疫组织化学染色强度是影响预后的独立危险因素（P＜0.05）。  结论  本研究发现淋巴结分期、肿瘤标记物CA199升高及AFP染色强度是预后不良的独立危险因素,多学科查房制定综合治疗策略争取根治可改善预后。      

胃肝样腺癌：在摸索和争议中前进

胃肝样腺癌（hepatoid adenocarcinoma of stomach,HAS）是一种特殊类型的胃癌。其发病率不高,但由于HAS具有高度侵袭性的生物学行为,容易发生淋巴转移及肝转移,预后较差,受到临床广泛关注。随着HAS临床病理特征、预后以及分子生物学特征等的持续研究,关于HAS的认识正不断深入。然而,目前在HAS研究领域仍存在一些容易被忽视并亟需解决的问题。本文梳理既往关于HAS的病例报道及研究,在HAS的范畴、起源、诊断方法、分子生物学特征及预后等方面进行总结和探讨,以期为HAS的后续研究提供一定方向。     

A case of coexistent adenocarcinoma and primary malignant lymphoma of the stomach

A case of a simultaneous adenocarcinoma and a primary malignant lymphoma of the stomach is presented. A sixty-one-year-old male was referred to us with epigastralgia. Gastroscopy and a biopsy revealed a *** c-like lesion in the stomach and, on histological examination, was determined as being an adenocarcinoma. A proximal gastrectomy and an R2-resection of lymph nodes then was performed. A pathological examination of the resected stomach disclosed a malignant lymphoma neighboring the adenocarcinoma. The presence of a simultaneous carcinoma and a malignant lymphoma of the stomach is quite rare, with only twenty-eight documented patients reported in the Japanese literature. This entity is discussed.     

A case of coexisting primary malignant lymphoma and adenocarcinoma of the stomach

Reports of the presence of two histologically different neoplasms in one organ are still unusual. We experienced a rare case of coexisting primary malignant lymphoma and adenocarcinoma of the stomach. A 66-year-old woman was admitted in April 1983 because of weight loss and epigastralgia. Several examinations including gallium scan, upper GI endoscopy, biopsy and touch cytology of the stomach, were performed, and she was diagnosed as having primary malignant lymphoma (noncleaved, large cell type) of the stomach. After the administration of 20 mg of vincristine, 6,000 mg of cyclophosphamide, 1,000 mg of prednisolone and 150 mg of Adriamycin, she improved to complete remission in August 1983. In February 1984, she received gastrectomy because of stenosis of the esophagogastric junction. Microscopic examination of the ulcerated lesion at esophagogastric junction revealed moderately differentiated tubular adenocarcinoma infiltrating to the subserosa. Despite chemotherapy, peritonitis carcinomatosa developed, and the patient died of cachexia in July 1984.     

A case of metastasis to the stomach from primary adenocarcinoma of the lung cancer

We report a case of gastric metastasis of lung cancer performed gastrectomy for the primary foci. A 70s woman was diagnosed as having right lung cancer and underwent right lower lobectomy and lymph node dissection. The histological diagnosis was adenocarcinoma (pT4, N2, M0). Four years later, positron emission tomography (PET)-CT revealed a tumor in the stomach and para-aortic lymph nodes swelling. The submucosal tumor was showed in the cardia by endoscopic examination. Biopsy showed a papillary adenocarcinoma. With the diagnosis of gastric metastasis from lung cancer, she was operated on. A proximal gastrectomy was carried out. The histopathological examination demonstrated papillary adenocarcinoma similar to that of the lung cancer with lymph node metastasis. No postoperative complications occurred and she was discharged from the hospital. Since then, she was treated with adjuvant chemotherapy as an outpatient.     

胃肝样腺癌:1例报告

Objective:We reported a case with AFP produced gastric hepatoid adenocarcinoma.Methods:A male patient,77 year-old,was admitted to our hospital due to an unreasonable elevation of serum AFP.The tumors were revealed by PET-CT,but until the tumors were removed during the surgery,we did not recognize the primary lesion was the gastric cancer.Results:Radical distal gastrectomy was performed.The gastric lesion was confirmed by histology as a hepatic adenocarcinoma in its early stage.Conclusion:The rare etiology o...     

胃肝样腺癌诊疗现状及进展

本文主要介绍胃癌当中一种很少见的特殊亚型,胃肝样腺癌,这种腺癌在发病机制、病理、治疗与预后方面与传统胃癌有较大区别。因其兼有胃癌及肝细胞癌的特征,很容易在临床上造成漏诊与误诊,因此我们有必要把胃肝样腺癌与胃癌区分开来,进一步提高胃肝样腺癌的诊出率,并降低其死亡率,延长生存期。     

Hepatoid adenocarcinoma of the stomach

Hepatoid adenocarcinoma of the stomach is a gastric cancer with both adenocarcinoma and hepatocellular differentiation. It usually produces large amounts of alpha-fetoprotein (AFP). This carcinoma often occurs in the aged and commonly in the antrum. The prognosis is poor because of frequent liver metastasis. In the cytoplasm of the tumor cells, various serum proteins were identified, such as AFP, alpha-I antitrypsin (AAT) and alpha-I antichymotrypsin (ACT). Adenocarcinomatous foci were composed of well-differentiated intestinal type epithelial cells and often contained carcinoembryonic antigen (CEA).     

Papillary adenocarcinoma of the stomach

Background. Papillary gastric carcinoma (PGC) is a rare histologic entity among gastric adenocarcinomas. The aim of this study was to clarify the clinicopathologic characteristics of PGC, including the survival rate, recurrence pattern, and factors influencing the prognosis of patients with PGC. Methods. The clinicopathologic findings of 65 patients with PGC and 566 patients with non-papillary gastric carcinoma (NGC) were examined and compared. The tumor was classified as PGC when more than 50% of the tumor area contained papillary structures. Survival rates were calculated using the Kaplan-Meier method and were assessed by the generalized Wilcoxon test. Prognostic factors were evaluated by univariate analysis, using the χ² test and Student's t-test, and confirmed by multivariate analysis, using the Cox proportional hazards model. Results. PGC was characteristically found in patients over 65 years of age (68%), was located in the upper one-third of the stomach (37%), was of grossly localized type (85%), was negative for serosal invasion (86%), and was associated with liver metastasis (14%). The overall 5-year survival rate for patients with PGC was significantly lower than the rate for those with NGC (63% vs 76%) (P < 0.05). Although the 5-year survival rate for each stage of PGC and NGC did not differ significantly, the death of PGC patients was more frequently associated with liver metastasis (62%) than with peritoneal dissemination (5%). Independent prognostic factors of PGC were liver metastasis, serosal invasion, and lymph node metastasis. Conclusion. These results suggest that PGC is characterized by advanced patient age, proximal tumor location, grossly localized type, negative serosal invasion, and frequent liver metastasis. A poor prognosis for patients with PGC is associated with the presence or recurrence of liver metastasis. Received: January 11, 2000 / Accepted: April 7, 2000     

Hepatoid adenocarcinoma of the stomach

Received: January 9, 2001 / Accepted: March 13, 2001     

A clinicopathologic study of mucinous adenocarcinoma of the stomach

Background. Mucinous adenocarcinoma of the stomach is a rare histologic type of gastric adenocarcinoma and its features are still controversial. We attempted to clarify the clinicopathologic characteristics of this histologic type. Methods. We reviewed the records of 112 patients with mucinous adenocarcinoma of the stomach (MUC) and 4160 patients with nonmucinous gastric adenocarcinoma (NMUC) for factors including age; sex; tumor location, size, and depth; lymph node metastasis; lymphatic or venous permeation; peritoneal dissemination; liver metastasis; and survival rate. We also investigated the relationship between cancer depth and lymph node metastasis. Statistical analysis included χ ² and Student's t -tests. Survival rates were calculated by the Kaplan-Meier method and analyzed by the log rank test. Results. MUC was found mostly in younger patients, in the lower part of the stomach and was of larger size, invading to or beyond the muscularis propria, positive for lymph node involvement, and associated with peritoneal dissemination. The overall 5-year survival rate in patients with MUC was lower than that in NMUC patients, because the MUC patients more frequently had advanced stage disease; however, the survival rates in the two groups did not differ significantly. As for the relationship between cancer depth and lymph node involvement, the frequency of lymph node metastasis increased when invasion reached the submucosa in patients with MUC compared with those with NMUC while the frequency of lymph node metastasis increased in the muscularis propria in patients with NMUC compared with those with NMUC. Conclusion. MUC was characteristically found in younger patients, at lower sites, at an advanced stage, and with peritoneal dissemination; MUC had a poor prognosis. Lymph node metastasis should be suspected when MUC invades to the submucosa or deeper. Received: March 14, 2001 / Accepted: June 18, 2001