Wang Tan, Matsuda Yoko, Seki Atsuko, Nonaka Keisuke, Kakizaki Mototsune, Kaneda Daita, Takahashi-Fujigasaki Junko, Murayama Shigeo, Arai Tomio
Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Case Rep Gastroenterol. 2017 Sep 26;11(3):545-553. doi: 10.1159/000479223. eCollection 2017 Sep-Dec.
Carbohydrate antigen 19-9 (CA19-9) is a well-known tumor marker for pancreatobiliary cancer, and several studies have shown that an elevated serum CA19-9 level is associated with more aggressive biological behavior in gastric cancer (GC). However, the clinicopathological characteristics of CA19-9-positive GC remain unclear. We herein report an autopsy case of CA19-9-positive GC in an 84-year-old man who was admitted to our hospital because of paralysis and anemia. Autopsy revealed an ulcerative-invasive tumor measuring 72 × 60 mm in the anterior wall of the gastric body. The tumor had invaded beyond the muscularis propria, and metastasized to the lung, liver, and regional lymph nodes. Histologically, the tumor cell had oval nuclei with abundant clear cytoplasm, and tubular and/or papillary features with prominent lymphovascular permeation and perineural invasion, mimicking pancreatobiliary carcinoma. Immunohistochemically, the tumor cells showed diffuse immunopositivity for CA19-9 and carcinoembryonic antigen. According to a review of cases reported in the literature, CA19-9-positive GCs show clinicopathological characteristics such as antral location, ulcerative-infiltrating gross feature, differentiated histology, prominent lymphatic and venous invasion, higher proportion of metastasis, and higher clinical stage. These results suggest that CA19-9-positive GC is pathologically a distinctive type of tumor with aggressive biological behavior.
糖类抗原19-9（CA19-9）是一种众所周知的胰胆管癌肿瘤标志物，多项研究表明，血清CA19-9水平升高与胃癌（GC）更具侵袭性的生物学行为相关。然而，CA19-9阳性胃癌的临床病理特征仍不清楚。我们在此报告一例84岁男性CA19-9阳性胃癌的尸检病例，该患者因瘫痪和贫血入院。尸检发现胃体前壁有一个72×60mm的溃疡性浸润性肿瘤。肿瘤已侵犯固有肌层以外，并转移至肺、肝和区域淋巴结。组织学上，肿瘤细胞具有椭圆形核，胞质丰富且清亮，呈管状和/或乳头状特征，伴有明显的淋巴管浸润和神经周围浸润，类似胰胆管癌。免疫组化显示，肿瘤细胞对CA19-9和癌胚抗原呈弥漫性免疫阳性。根据对文献报道病例的回顾，CA19-9阳性胃癌具有一些临床病理特征，如位于胃窦、溃疡性浸润性大体特征、组织学分化、明显的淋巴管和静脉浸润、转移比例较高以及临床分期较高。这些结果表明，CA19-9阳性胃癌在病理上是一种具有侵袭性生物学行为的独特肿瘤类型。
