摘要
Abstract
Objective:Hepatoid adenocarcinoma of the stomach(HAS)is a rare subtype of gastric cancer with morphology resembling hepatocellular carcinoma.Some cases show immunohistochemical expression of neuroendocrine markers,and in a small subset the expression is pronounced.This study aims to provide assistance in improving the clinical diagnostic level of patients with significant neuroendocrine immunohistochemical features of HAS through retrospective analysis of patients'clinical data.
Methods:We enrolled patients with HAS with marked neuroendocrine immunohistochemical features from the First Affiliated Hospital of Soochow University.All patients exhibited typical pathological characteristics of HAS and expressed at least one neuroendocrine immunohistochemical marker,synaptophysin(Syn)or chromogranin A(CgA).We retrospectively analyzed patients'general clinical data,gross tumor morphology,HE staining results,and immunohistochemical findings.
Results:Thirteen patients were 11 males and 2 females aged 55-79(67.9±8.8)years.Serum alpha fetoprotein(AFP)levels ranged from 14.73 to 902.54 μg/L.Tumor locations included cardia(5 patients),fundus(2 patients),angularis(2 patients),and antrum(4 patients).Tumor maximum diameters ranged from 2.5 to 10.0 cm;cut surfaces were gray-white.One tumor was Borrmann type I(polypoid)and 12 were Borrmann type Ⅲ(ulcerative).Microscopically,tumor cells were arranged diffusely in sheets or in nodules with rich sinusoidal vasculature.The cells were polygonal,medium to large,with eosinophilic,basophilic,or clear cytoplasm;mitotic figures,including abnormal mitoses,were readily seen,and eosinophilic material was present in some lumina or cytoplasm.Among the 13 HAS patients,spalt-like transcription factor 4(SALL4)was positive in 11,AFP in 6,glypican-3(GPC3)in 4,Syn in 13,CgA in 12,CD56 in 7,insulinoma-associated protein 1(INSM1)in 7,and cytokeratin 7(CK7)in 4.Ki-67 proliferation index ranged from 60％to 90％.Human epidermal growth factor receptor 2(HER-2)expression was 0 in 9 and 1+in 4.One patient received neoadjuvant chemotherapy before surgery and postoperative chemotherapy;8 received only postoperative chemotherapy;4 received no chemotherapy.During 3-57 months of follow-up,7 patients died of tumor progression and 6 survived.
Conclusion:HAS can exhibit pronounced neuroendocrine immunohistochemical characteristics and has a poor prognosis.Recognizing the potential for HAS to display significant neuroendocrine features can improve understanding of this tumor and reduce misdiagnosis or missed diagnosis.关键词
胃肝样腺癌/神经内分泌/免疫组织化学特征/突触素/嗜铬粒蛋白AKey words
hepatoid adenocarcinoma of the stomach/neuroendocrine/immunohistochemical characteristics/synaptophysin/chromogranin A
