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。

A Preliminary Study on the Clinical and Pathologic Relevance in Gastric Hepatoid Adenocarcinoma

Background: Gastric hepatoid adenocarcinoma (GHAC) has its own histological characteristics and clinical features, which have not received much concern by our physicians and pathologists. Aims: To appraise the histological and clinical features, and prognosis of AFP+ GHAC patients. Methods: Surgical specimens of 6 cases of GHAC were evaluated for histology, immunohistochemistry and clinical data from January 2001 to December 2003 in Ruijin Hospital. Thirty cases of gastric poorly differentiated adenocarcinoma and hepatocellular carcinoma (HCC) were also taken as controls. Results: The average age of the 6 GHAC patients was 66.8 years, serum AFP level was between 84 to 2230 ng/ml. Of the 6 patients, 2 had recurrent cancer and 2 hepatic metastasis. The average survival period was 17 months. Morphologically, the tumors were characterized by mixed tubulo-, and papillary adenocarcinoma with hepatoid histology: the tumor cells were consisted of glycogen granules and hyaline globules arranged in a solid or trabecular pattern, separated by plentiful sinusoid-like blood vessels. Tumor invasion of blood vessels and lymphatics were frequently noted. Immunohistochemically, the cancer cells were positive for AFP but negative for HepPar1, and were seperated by CD34+ blood vessels into trabecular pattern. Gastric poorly differentiated adenocarcinoma had a solid trabecular or diffuse pattern with negative AFP and HepPar1. In HCC, the histologic features were mainly solid, or trabecular in which plentiful sinusoid-like blood vessels were present and the tumor cells were positive for HepPar1. Conclusions: Serum AFP+ GHAC patients had its own clinical features, such as higher incidence in the elderly, aggressive, with higher recurrence rate or hepatic metastasis and poor prognosis. Histologically, GHAC and HCC were similar but immunohistochemistry was valuable for their differentiation, of which the tumor cells of GHAC were AFP positive and HepPar1 negative, whereas the tumor cells of gastric poorly differentiated adenocarcinoma were both AFP and HepPar1 negative, and those of HCC were both AFP and HepPar1 positive.