论文信息 - A CASE OF HEPATOID ADENOCARCINOMA OF THE STOMACH WITH NO ELEVATION IN SERUM AFP LEVEL

A CASE OF HEPATOID ADENOCARCINOMA OF THE STOMACH WITH NO ELEVATION IN SERUM AFP LEVEL

症例は79歳の男性。心窩部痛にて近医受診し,精査加療目的で当院へ紹介入院となった.血液生化学検査では貧血および低タンパク血症を認めたが, AFP, CEA, CA19-9は全て正常範囲内であった.胃X線および内視鏡検査で胃体上部小彎後壁に最大径6.0cmのBorrmann2型癌を認めた.手術所見はT2, N1, P0, H0, M0, Stage IIで,胃全摘術+D2郭清,脾合併切除術を施行した.切除標本で左胃静脈内に粥状の腫瘍塞栓を認めた.病理組織学的には乳頭状あるいは管状構造を示す腺癌部と充実胞巣状構造を示す肝様部が認められ,免疫組織染色では肝様部がAFP陽性を示した.以上の所見から胃肝様腺癌 (hepatoid adenocarcinoma), ss, med, INFα, ly2, v2, n1(+)と診断された.静脈内腫瘍塞栓は肝様部と同様の組織像を呈していた.術後14カ月経過の現在,再発転移の徴候はない.血清AFP値の上昇を伴わない胃肝様腺癌は比較的稀であると考え,文献的考察を加えて報告した.

K. Hirata | M. Kawamoto | T. Takashima | T. Oku

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