摘要
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 2 0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 ,类似于毛细胆管结构 ,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 4 4 % (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。
Objective To investigate the morphological features,biological behavior ,and diagnosis and treatment of gastric hepatoid adenocarcinoma(GHA).MethodsTwenty GHA cases were evaluated. Of the 20 patients,14 underwent radical gastrectomy, 3 total gastrectomy,3 total gastrectomy and wedge excision of the liver metastasis.ResultsHistologically,hyaline globules and venous invasion were common features of GHA.Tumor cells were immunohistochemically positive for alpha fetoprotein(AFP), alpha antitrypsin(AAT), and alpha antichymotrypsin(ACT). Ultrastructurally,tumor cells were arranged toward the lumens with microvilli on the luminal surfaces.There were junctional complexes between the lateral plasma membranes of adjacent tumor cells.Patients were followed up for 1～5 years with 12 deaths, 11 died of metastasis and one died of intraabdominal tumor seeding. The 1, 3 year survival rate was 44%(8/18), and 17%(3/18), respectively. Conclusions GHA deriving from gastric mucosa is characterized both by the histologic structures of hepatoid differentiation and adenocarcinoma.The prognosis is usually poor due to frequent liver metastasis.
出处
《中华普通外科杂志》
CSCD
北大核心
2002年第8期456-458,共3页
Chinese Journal of General Surgery
