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伴有神经内分泌分化的产甲胎蛋白肝样胃腺癌：一例报告

Α-fetoprotein producing hepatoid gastric adenocarcinoma with neuroendocrine differentiation: A case report.

作者信息

Li Tao, Liu Tongjun, Wang Min, Zhang Mingwei

机构信息

Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, China.

出版信息

Medicine (Baltimore). 2018 Sep;97(37):e12359. doi: 10.1097/MD.0000000000012359.

DOI:10.1097/MD.0000000000012359
PMID:30212993
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6156028/
Abstract

RATIONALE

Hepatoid gastric adenocarcinoma is a rare type of gastric cancer. The phenomenon of neuroendocrine differentiation (NED) in gastrointestinal tumor needs further research. Both hepatoid adenocarcinoma and neuroendocrine differentiation are the factors leading to a poor prognosis of gastric cancer. However, there is still no specific treatment.

PATIENT CONCERNS

A 60-year-old man who had a pain and distention in his upper abdomen presented melena. Gastroscopy and pathology revealed a gastric cancer.

DIAGNOSES

Postoperative pathology revealed a hepatoid gastric adenocarcinoma. Immunohistochemical analysis showed a-fetoprotein (AFP), hepatocyte, synaptophysin (Syn), and chromogranin A (CgA) positive, and Ki67 60% positive. A-fetoprotein producing hepatoid gastric adenocarcinoma with NED is diagnosed.

INTERVENTIONS

The patient was treated with an R2 radical gastrectomy, but refused chemotherapy.

OUTCOMES

The AFP level was >2000 ng/mL (0-8.78) half a year after the surgery. There was no obvious abnormality from computed tomography (CT). The patient refused positron emission tomography computed tomography (PET-CT) and left the hospital.

LESSONS

Hepatoid adenocarcinoma and neuroendocrine differentiation are the factors leading to a poor prognosis of gastric cancer. It relapses easily. Long-term follow-up and regular examinations are necessary to detect relapses.

摘要

理论依据

肝样型胃腺癌是一种罕见的胃癌类型。胃肠道肿瘤中的神经内分泌分化（NED）现象需要进一步研究。肝样腺癌和神经内分泌分化都是导致胃癌预后不良的因素。然而，目前仍没有特异性治疗方法。

患者情况

一名60岁男性，上腹部疼痛、胀满，出现黑便。胃镜及病理检查显示为胃癌。

诊断

术后病理显示为肝样型胃腺癌。免疫组化分析显示甲胎蛋白（AFP）、肝细胞、突触素（Syn）和嗜铬粒蛋白A（CgA）呈阳性，Ki67阳性率为60%。诊断为伴有NED的产甲胎蛋白肝样型胃腺癌。

干预措施

患者接受了R2根治性胃切除术，但拒绝化疗。

结果

术后半年，AFP水平>2000 ng/mL（0 - 8.78）。计算机断层扫描（CT）未发现明显异常。患者拒绝正电子发射断层扫描计算机断层扫描（PET - CT）并出院。

经验教训

肝样腺癌和神经内分泌分化是导致胃癌预后不良的因素。其容易复发。需要长期随访和定期检查以发现复发情况。

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