伴有肝样或肠母细胞分化胃腺癌的临床病理学观察

目的探讨伴有肝样或肠母细胞分化胃腺癌(GAHED)的临床病理学特征及诊断方法。方法收集7例GAHED,回顾性分析其临床特点、形态学表现及免疫表型,并进行相关文献复习。结果组织学上,所有肿瘤均由不同比例的管状、筛状、乳头状、实体和(或)小梁状生长模式构成,肿瘤细胞胞质透明或轻度嗜酸性,所有病例肿瘤细胞胞质可见嗜酸性小体。免疫组化方面,肿瘤细胞弥漫或局灶表达胚胎性或肝样分化标记物(SALL4、AFP、Glypican-3和Hepatocyte)中的一种或多种,其中Glypican-3是最敏感的标记物(阳性率100%)。5例p53呈突变型表达(阳性率71.4%)。7例患者均获得了临床随访资料,随访时间7~32个月,2例患者无瘤生存,2例伴瘤生存,3例死亡,其中2例伴有肝转移,1例伴有肝及其他脏器转移。结论GAHED不同于普通型胃腺癌,是一种罕见且高度侵袭性腺癌亚型,其组织学和免疫表型上都具有特征性的改变,临床和病理医生应熟知此特殊类型胃癌的临床和病理学特征,以便做出正确诊断和处理。

Clinicopathologic Study of Gastric Adenocarcinoma with Hepatoid or Enteroblastic Differentiation

Objective To study the clinicopathologic features and diagnostic methods of gastric adenocarcinoma with hepatoid or enteroblastic differentiation(GAHED).Methods 7 cases of GAHED were collected,The clinical features,morphological features and immunophenotype of them were retrospectively analyzed and related literatures were reviewed.Results Histologically,all tumours were composed of various proportions of tubular,cribriform,papillary,solid,and/or trabecular growth patterns with clear to slightly eosinophilic tumour cells.Hyaline globules were observed in all cases.Immunohistochemically,all GAHED were positive for at least one of four embryonic or hepatoid differentiation markers(SALL4,AFP,glypican-3,and hepatocyte),Glypican-3 was the most sensitive marker(100%)for GAHED.5 cases of P53 showed mutant expression(71.4%).Clinical follow-up was available in all cases,and the follow-up time was 7-32 months,2 patients survived without tumor,2 survived with tumor,3 died,and 2 of them had liver metastasis,1 had liver and other organ metastasis.Conclusions Compared with common gastric adenocarcinoma,GAHED is a rare and highly aggressive subtype of adenocarcinoma,which possess unique histological and immunohistochemical characteristics.So clinicians and pathologists should be familiar with the clinicopathological features of this particular subtype in order to make an accurate diagnosis and treatment.