Ishikura H, Kishimoto T, Andachi H, Kakuta Y, Yoshiki T
Department of Pathology, Hokkaido University School of Medicine, Sapporo, Japan.
Histopathology. 1997 Jul;31(1):47-54. doi: 10.1046/j.1365-2559.1997.5740812.x.
Four cases of hepatoid adenocarcinoma, three in the stomach, and one in the sigmoid colon, are presented to emphasize venous permeation and mimicry of hepatocellular carcinoma by metastatic liver nodules.
Tumour cells in all cases extensively invaded vems, and intravenous tumour thrombi in two cases were grossly observed as anastomosing, worm-like cords up to 10 mm in diameter in the lesser omentum and mesentery in continuity with the primary mucosal lesions. The cytological features and trabecular architecture of the metastatic liver nodules in these subjects mimicked primary hepatocellular carcinoma. In a third case the tumour contained grossly visible bile in a metastatic lung nodule, but there was no evidence of bile production in the primary gastric or metastatic liver lesions. In the fourth case, detailed histopathological study revealed a gastric origin of the hepatoid adenocarcinoma, rather than primary hepatocellular carcinoma metastatic to the stomach, the initial diagnosis.
These cases are reported here to draw attention to this rare variant of gastrointestinal adenocarcinoma, its mimicry of hepatocellular carcinoma when metastatic to the liver and other sites, and its propensity for venous permeation.
报告4例肝样腺癌，其中3例位于胃，1例位于乙状结肠，以强调静脉浸润以及转移性肝结节对肝细胞癌的模仿。
所有病例的肿瘤细胞均广泛侵犯静脉，2例可见静脉内肿瘤血栓，大体观察为吻合的、蠕虫状条索，直径达10毫米，位于小网膜和肠系膜，与原发性黏膜病变相连。这些患者转移性肝结节的细胞学特征和小梁结构模仿原发性肝细胞癌。第3例患者的肿瘤在转移性肺结节中肉眼可见胆汁，但原发性胃或转移性肝病变中无胆汁生成证据。第4例患者，详细的组织病理学研究显示肝样腺癌起源于胃，而非最初诊断的原发性肝细胞癌转移至胃。
本文报告这些病例是为了引起对这种罕见的胃肠道腺癌变体的关注，其转移至肝脏和其他部位时对肝细胞癌的模仿，以及其静脉浸润倾向。
