肝樣胃癌的臨床病理特征預(yù)后及研究展望培訓(xùn)課程課件

肝樣胃癌的臨床病理特征預(yù)后及研究展望（優(yōu)選）肝樣胃癌的臨床病理特征預(yù)后及研究展望新生幼稚肝細(xì)胞（未分化完全）分泌AFP量很大

肝癌細(xì)胞（尚未分化的肝細(xì)胞）80-90%Hcc患者血清AFP增高肝細(xì)胞癌Hcc—90%肝外膽管細(xì)胞癌Hcc—10%原發(fā)性肝癌甲胎蛋白是診斷原發(fā)性肝癌的一個(gè)特異性臨床指標(biāo)。However!!EXCEPTION!!!!EXCEPTION!!部分肝硬化病人會(huì)長(zhǎng)期出現(xiàn)AFP達(dá)到上千，但多年都沒(méi)有肝癌的跡象。同時(shí)發(fā)現(xiàn)約20%的晚期肝癌病人，直至病故前，AFP仍不超過(guò)10。

AFP與腫瘤大小有一定的相關(guān)性，即腫瘤越小，陽(yáng)性率越低。AFP也與病理類型相關(guān)，癌細(xì)胞分化I級(jí)和II級(jí)，AFP相對(duì)較低，Ⅲ級(jí)時(shí)相對(duì)較高。SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.血清甲胎蛋白增高的原因

肝癌（陽(yáng)性率80-90%）隨著病情惡化它在血清中的含量會(huì)急劇增加

急性肝炎慢性肝炎肝硬化孕婦;其他腫瘤的肝轉(zhuǎn)移一過(guò)性升高隨著病情的恢復(fù)，血清甲胎蛋白值會(huì)下降

生殖細(xì)胞腫瘤陽(yáng)性率50%AFP陽(yáng)性alpha-fetoprotein-producinggastriccancer(AFPGC)Hepatoidadenocarcinomaofthestomach(HAS)Concept:

alpha-fetoprotein-producinggastriccancer(AFPPGC)Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevelConceptofHAS1.Hepatoidadenocarcinomaisakindofextrahepatictumorpresentingmorphologicalareasidenticaltothatofhepatocellularcarcinomas.2.Inadditiontothehistologicalsimilarity,itcanalsoproduceAFP-likehepatocellularcarcinomasAmemiyaetal.alpha-fetoprotein-producinggastriccancer(AFPGC)肝樣胃癌的臨床病理特征預(yù)后及研究展望80-90%Hcc患者血清AFP增高外院胃鏡病理我院會(huì)診意見(jiàn)：（胃竇小彎）腺癌Amemiyaetal.部分肝硬化病人會(huì)長(zhǎng)期出現(xiàn)AFP達(dá)到上千，但多年都沒(méi)有肝癌的跡象。morphologicalareasidenticaltothatofhepatocellularcarcinomas.AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.ConceptofHAS!!EXCEPTION!!肝細(xì)胞癌Hcc—90%Hepatoidadenocarcinomaofthestomach(HAS)SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.外院胃鏡病理我院會(huì)診意見(jiàn)：（胃竇小彎）腺癌alpha-fetoprotein-producinggastriccancer(AFPPGC)PatientsCharacteristicsNoCorrelationAnalysis我們科室AFPPGC與對(duì)照胃癌患者的總生存比較肝樣胃癌的臨床病理特征預(yù)后及研究展望Amemiyaetal.80-90%Hcc患者血清AFP增高80-90%Hcc患者血清AFP增高SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.Hepatoidadenocarcinomaofthestomach(HAS)PatientsCharacteristicsmorphologicalareasidenticaltothatofhepatocellularcarcinomas.外院胃鏡病理我院會(huì)診意見(jiàn)：（胃竇小彎）腺癌外院胃鏡病理我院會(huì)診意見(jiàn)：（胃竇小彎）腺癌Inadditiontothehistologicalsimilarity,itcanalsoproduceSomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.（陽(yáng)性率80-90%）AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.CanAFPberoutinelycheckedincircularbloodandgastrictissuesbyIHC?morphologicalareasidenticaltothatofhepatocellularcarcinomas.SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.!!EXCEPTION!!Hepatoidadenocarcinomaisakindofextrahepatictumorpresenting49.2%11.5%75.6%morphologicalareasidenticaltothatofhepatocellularcarcinomas.肝外膽管細(xì)胞癌Hcc—10%AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.Amemiyaetal.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.AFP-likehepatocellularcarcinomasmorphologicalareasidenticaltothatofhepatocellularcarcinomas.SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.隨著病情的恢復(fù)，血清甲胎蛋白值會(huì)下降A(chǔ)FP也與病理類型相關(guān)，癌細(xì)胞分化I級(jí)和II級(jí)，AFP相對(duì)較低，Ⅲ級(jí)時(shí)相對(duì)較高。同時(shí)發(fā)現(xiàn)約20%的晚期肝癌病人，直至病故前，AFP仍不超過(guò)10。肝樣胃癌的臨床病理特征預(yù)后及研究展望AFPinclinicaluse:外院胃鏡病理我院會(huì)診意見(jiàn)：（胃竇小彎）腺癌Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.HASirrespectiveofAFPproductionhaveapoorerprognosisthanAFP-producinggastriccarcinomaswithouthepatoiddifferentiationHASshouldbedistinguishedfromAFPPGC.ConclusionWhy:HASmeanspoorprognosis?ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.Amemiyaetal.Foundthatc-Metover-expressedfrequentlyinAFP-producinggastriccancersthaninstage-matchedgastriccancersthatdidnotproduceAFP.TheseresultssuggestedthataggressivebehaviorofAFP-producinggastriccancermaybeassociatedwithover-expressedc-Met.Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?AFPinclinicaluse:CanAFPberoutinelycheckedincircularbloodandgastrictissuesbyIHC?CanAFPbeactedasabiomarkerofpoorprognosisandchemotherapyingastriccancer?AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.PatientsCharacteristics肝癌Foundthatc-Metover-expressedfrequentlyinAFP-producinggastriccancersthaninstage-matchedgastriccancersthatdidnotproduceAFP.Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevel肝外膽管細(xì)胞癌Hcc—10%外院胃鏡病理我院會(huì)診意見(jiàn)：（胃竇小彎）腺癌morphologicalareasidenticaltothatofhepatocellularcarcinomas.Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?肝樣胃癌的臨床病理特征預(yù)后及研究展望AFP與腫瘤大小有一定的相關(guān)性，即腫瘤越小，陽(yáng)性率越低。alpha-fetoprotein-producinggastriccancer(AFPPGC)PatientsCharacteristicsAFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.!!EXCEPTION!!AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.Hepatoidadenocarcinomaofthestomach(HAS)alpha-fetoprotein-producinggastriccancer(AFPPGC)Amemiyaetal.SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.（陽(yáng)性率80-90%）Amemiyaetal.AFP與腫瘤大小有一定的相關(guān)性，即腫瘤越小，陽(yáng)性率越低。同時(shí)發(fā)現(xiàn)約20%的晚期肝癌病人，直至病故前，AFP仍不超過(guò)10。隨著病情惡化它在血清中的含量會(huì)急劇增加80-90%Hcc患者血清AFP增高SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.80-90%Hcc患者血清AFP增高AFP與腫瘤大小有一定的相關(guān)性，即腫瘤越小，陽(yáng)性率越低。Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.ConceptofHASmorphologicalareasidenticaltothatofhepatocellularcarcinomas.SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.alpha-fetoprotein-producinggastriccancer(AFPPGC)外院胃鏡病理我院會(huì)診意見(jiàn)：（胃竇小彎）腺癌!!EXCEPTION!!alpha-fetoprotein-producinggastriccancer(AFPPGC)morphologicalareasidenticaltothatofhepatocellularcarcinomas.Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevel80-90%Hcc患者血清AFP增高!!EXCEPTION!!（陽(yáng)性率80-90%）morphologicalareasidenticaltothatofhepatocellularcarcinomas.肝細(xì)胞癌Hcc—90%TheseresultssuggestedthataggressivebehaviorofAFP-producinggastricca