Makino H, Takazakura E, Nakamura S, Kobayashi K, Hattori N, Nonomura A, Ohta G
Acta Pathol Jpn. 1986 Apr;36(4):577-86. doi: 10.1111/j.1440-1827.1986.tb01047.x.
A case of hepatocellular carcinoma with metastasis to the stomach and hyperlipidemia as a paraneoplastic syndrome was presented. The patient, a 69-year-old man, was admitted to Kurobe City Hospital with a complaint of epigastralgia. He was diagnosed as having hepatocellular carcinoma by an increased plasma AFP and the abnormalities of hepatic scintigram and abdominal angiography. Endoscopic examination of the stomach revealed an ulcerative lesion suggesting Borrmann type 2 gastric cancer and the gastric mucosal biopsy was interpreted as tubular adenocarcinoma. At autopsy, the liver was enlarged and weighed 4,170 g without liver cirrhosis. Histologic finding of the liver tumor was hepatocellular carcinoma of Edmondson's grade 2 and the gastric tumor with bile production was identical to that of liver tumor. The tumor architecture of the stomach, however, was mixed with trabecular pattern and tubular pattern near the site of gastric mucosa, and was concordant with the findings of gastric mucosal biopsy. Multiple tumor thrombi in the portal system suggested that hepatocellular carcinoma retrogradely metastasized to the stomach through the portal system.
本文报告一例肝细胞癌转移至胃并伴有副肿瘤综合征高脂血症的病例。患者为69岁男性，因上腹部疼痛入住黑部市医院。通过血浆甲胎蛋白升高以及肝脏闪烁扫描和腹部血管造影异常，诊断为肝细胞癌。胃部内镜检查发现溃疡性病变，提示为Borrmann 2型胃癌，胃黏膜活检结果为管状腺癌。尸检时，肝脏肿大，重4170克，无肝硬化。肝脏肿瘤的组织学检查结果为Edmondson 2级肝细胞癌，胃肿瘤伴有胆汁生成，与肝脏肿瘤相同。然而，胃肿瘤的结构在胃黏膜附近混合了小梁状和管状模式，与胃黏膜活检结果一致。门静脉系统中的多个肿瘤血栓表明，肝细胞癌通过门静脉系统逆行转移至胃。
