Petras R E, Hart W R, Bukowski R M
Cancer. 1985 Aug 15;56(4):745-50. doi: 10.1002/1097-0142(19850815)56:4<745::aid-cncr2820560408>3.0.co;2-q.
Hepatic arterial infusion chemotherapy (HAIC) for metastatic colonic carcinoma has been associated with gastric ulceration and marked epithelial atypia which may be mistaken for carcinoma. The authors reviewed the gastric histopathologic features of seven patients who developed gastric ulcers following HAIC and compared them with 20 examples of "early" gastric carcinoma. The seven patients had primary colonic carcinomas with hepatic metastases; each had received combination chemotherapy with mitomycin C and 5-fluorouracil via percutaneously placed hepatic arterial catheter. The gastric ulcers became clinically apparent 10 to 45 days after initiation of the final course of HAIC, usually heralded by severe epigastric pain. Based on the authors' observations, histologic features which are indicative of HAIC-associated atypia rather than carcinoma include: preservation of mucosal architecture; atypia accentuated in the basilar gastric glands; bizarre atypia with cellular enlargement exceeding that seen in carcinoma; preservation of a low nuclear-cytoplasmic ratio; cytoplasmic eosinophilia with vacuolization; few or no mitotic figures; cytologic resemblance to radiation effect; similar atypia within fibroblasts and endothelial cells; and absence of intestinal metaplasia in adjacent gastric epithelium.
肝动脉灌注化疗（HAIC）用于转移性结肠癌时，与胃溃疡及明显的上皮异型性有关，后者可能被误诊为癌。作者回顾了7例HAIC后发生胃溃疡患者的胃组织病理学特征，并与20例“早期”胃癌进行了比较。这7例患者患有原发性结肠癌伴肝转移；均通过经皮放置的肝动脉导管接受了丝裂霉素C和5-氟尿嘧啶联合化疗。胃溃疡在HAIC最后一个疗程开始后10至45天在临床上变得明显，通常以严重的上腹部疼痛为先兆。根据作者的观察，提示为HAIC相关异型性而非癌的组织学特征包括：黏膜结构保留；胃底部腺体异型性加重；细胞增大的怪异异型性超过癌所见；核质比低得以保留；细胞质嗜酸性变伴空泡形成；有丝分裂象很少或没有；细胞学上类似放射效应；成纤维细胞和内皮细胞内有类似的异型性；以及相邻胃上皮中无肠化生。
