Gastric adenocarcinoma with choriocarcinomatous and hepatoid differentiation

Basic and applied pathology Pub Date : 2011-12-14 DOI:10.1111/j.1755-9294.2011.01118.x

Seong Wook Hwang, Sun Jae Lee, Po Eun Park, Mee Seon Kim, Han-Ik Bae

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Abstract

We report a patient with gastric adenocarcinoma with choriocarcinomatous and hepatoid differentiation. A 67-year-old man visited our hospital for further evaluations due to gastric adenocarcinoma. The gastric cancer was located in the prepyloric area and appeared to be a protruding mass with an infiltrative growth pattern. Initial pancreatic and postoperative hepatic and pulmonary metastases were detected radiologically. Microscopically, choriocarcinomatous and hepatoid differentiation was observed with a moderately differentiated adenocarcinoma. The choriocarcinomatous components were positive for β-hCG and the hepatoid components were positive for α-fetoprotein (AFP). These uncommon pathological patterns are supposed to arise from the retrodifferentiation pathway of primary gastric adenocarcinoma. The preoperative laboratory data revealed elevated serum AFP (773.4 ng/mL) and carcinoembryonic antigen (62.2 ng/mL), whereas other tests were unremarkable. The prognosis of gastric adenocarcinoma with choriocarcinomatous and hepatoid differentiation is very poor; our patient died 4 months after the operation.

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胃腺癌伴绒毛膜癌和肝样分化

我们报告一例胃腺癌合并绒毛膜癌和肝样分化的病例。一名67岁男性因胃腺癌来我院作进一步检查。胃癌位于幽门前区，呈浸润性生长的突出肿块。最初的胰腺和术后的肝和肺转移用放射学检测。镜下可见绒毛膜癌和肝样分化，伴中度分化腺癌。绒毛膜癌成分β-hCG阳性，类肝成分α-胎蛋白(AFP)阳性。这些不常见的病理模式被认为是由原发性胃腺癌的后分化途径引起的。术前实验室数据显示血清AFP (773.4 ng/mL)和癌胚抗原(62.2 ng/mL)升高，而其他检查无显著差异。胃腺癌合并绒毛膜癌和肝样分化的预后很差;我们的病人在手术后4个月死亡。

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Basic and applied pathology

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