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胃肝样腺癌是临床上较少见的一种胃癌,这种癌含腺癌和肝细胞样分化的癌细胞故AFP可呈阳性,该种癌常长成结节或巨块状,有广泛的脉腺瘤栓,预后差。最近我们发现二例胃肝样腺癌AFP升高,现将结果报告如下。 例一:患者男性,42岁。1997年1月24日本院体检发现AFP370.2ng/ml。B超、CT均未见肝脏有明显改变。患者神清,精神佳,无食欲不振,胃纳正常,大小便正常。无肝炎、血吸虫和伤寒史。肝肾功能正常。 1月30日复查AFP404.3ng/ml,CEA<15ng/ml。2月2日AFP404.1ng/ml,2月7日AFP 405.9ng/ml。数次复查AFP均呈高水平,CEA均正常。CT、B超反复检查肝脏无异常发现。3月5日B超示肝胃韧带处有2cm大小肿块性质待定。同日GI示胃小弯侧溃疡性病变3×4cm大小。3月7日胃镜结果与GI相似,病理活检胃窦部粘膜中分化腺癌,脉管内瘤栓形成。从而诊断为胃肝样腺癌。
Gastric hepatoid adenocarcinoma is a clinically rare type of gastric cancer. This cancer contains adenocarcinoma and hepatocyte-like differentiated cancer cells, so AFP can be positive. The cancer often grows into nodules or massive masses. Extensive vein aneurysm bolts have a poor prognosis. Recently we have found two cases of elevated hepatic adenocarcinoma AFP. The results are reported below. Example 1: The patient is male, 42 years old. January 24, 1997, the Japanese Institute of Physical Examination found AFP 370.2ng/ml. There was no significant change in the liver in B-mode ultrasound and CT. The patient was clear-headed, with good spirits, no appetite, normal appetite, and normal urine and urine. No history of hepatitis, schistosomiasis and typhoid fever. Liver and kidney functions are normal. On January 30th, AFP was reviewed at 404.3ng/ml, and CEA was <15ng/ml. February 2 AFP 404.1ng/ml, February 7th AFP 405.9ng/ml. AFP was high in several reviews, and CEA was normal. CT, B ultrasound repeatedly found no abnormal liver. On March 5, B ultrasound showed that the mass of 2cm in the hepatic ligament was to be determined. On the same day, the GI showed a size of 3 × 4cm in the small gastric ulcer. On March 7, the gastroscopy findings were similar to those of GI. Histopathological biopsy of differentiated adenocarcinoma in the mucosa of the gastric antrum and formation of intravascular tumor plugs were performed. Thus diagnosed as gastric hepatoid adenocarcinoma.