Kudo M, Takamine Y, Nakamura K, Shirane H, Uchida H, Kasakura S, Kajiwara T, Ibuki Y, Hirasa M, Tomita S
Department of Medicine, Kobe City General Hospital, Japan.
Am J Gastroenterol. 1992 Dec;87(12):1859-62.
We describe the case of a 56-yr-old man with primary gastric adenocarcinoma, who had an extremely high plasma level of des-gamma-carboxy prothrombin (2.45 AU/ml) and of serum alpha-fetoprotein (2810 ng/ml). Histopathologically, the gastric cancer was a IIc type of early cancer which consisted of a combination of a poorly differentiated adenocarcinoma and a well-differentiated tubular adenocarcinoma. The association of a hepatic tumor including hepatocellular carcinoma or liver metastasis was ruled out by ultrasonography, computed tomography, radiocolloid liver scan, magnetic resonance imaging, and angiography. Foci strongly resembling hepatocellular carcinoma (hepatoid differentiation) were noted in the gastric tumor. Localization of des-gamma-carboxy prothrombin and alpha-fetoprotein within the tumor cells, especially within the hepatoid differentiated foci, was demonstrated by the immunohistochemical staining of tissue obtained at biopsy and the resected specimen. This case seems to be the first case reported in which des-gamma-carboxy prothrombin was produced by the gastric cancer. This finding supports the theory of hepatoid differentiation of a gastric cancer.
我们描述了一名56岁原发性胃腺癌男性患者的病例，其血浆去γ-羧基凝血酶原水平极高（2.45 AU/ml），血清甲胎蛋白水平也很高（2810 ng/ml）。组织病理学检查显示，胃癌为IIc型早期癌，由低分化腺癌和高分化管状腺癌混合组成。通过超声检查、计算机断层扫描、放射性胶体肝扫描、磁共振成像和血管造影排除了包括肝细胞癌或肝转移在内的肝脏肿瘤。在胃肿瘤中发现了与肝细胞癌极为相似的病灶（肝样分化）。通过对活检和切除标本进行组织免疫组化染色，证实去γ-羧基凝血酶原和甲胎蛋白在肿瘤细胞内定位，尤其是在肝样分化灶内。该病例似乎是首例报道的由胃癌产生去γ-羧基凝血酶原的病例。这一发现支持了胃癌肝样分化的理论。
