肝样胃癌的临床病理特征预后及研究展望培训课程课件.ppt

1、肝样胃癌的临床病理特征预后及研究展望（优选）肝样胃癌的临床病理特征预后及（优选）肝样胃癌的临床病理特征预后及研究展望研究展望新生幼稚肝细胞（未分化完全）分泌AFP量很大 肝癌细胞（尚未分化的肝细胞）80-90%Hcc患者血清AFP增高增高肝细胞癌Hcc90%肝外胆管细胞癌Hcc10%原发性肝癌v甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。However!EXCEPTION!EXCEPTION!v 部分肝硬化病人会长期出现AFP达到上千，但多年都没有肝癌的迹象。v 同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。v AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。v A

2、FP也与病理类型相关，癌细胞分化I级和II级，AFP相对较低，级时相对较高。Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.血清甲胎蛋白增高的原因血清甲胎蛋白增高的原因 肝癌（阳性率80-90%）随着病情恶化它在血清中的含量会急剧增加 急性肝炎急性肝炎慢性肝炎慢性肝炎肝硬化肝硬化孕妇;其他肿瘤的肝转移一过性升高随着病情的恢复，血清

3、甲胎蛋白值会下降 生殖细胞肿瘤阳性率50%AFP阳性alpha-fetoprotein-producing gastric cancer(AFPGC)Hepatoid adenocarcinoma of the stomach(HAS)Concept:alpha-fetoprotein-producing gastric cancer(AFPPGC)At present time,it was generally accepted that the diagnostic criteria of AFP-producing gastric cancer was positive staining

4、 of AFP in primary lesion regardless of serum AFP levelConcept of HAS 1.Hepatoid adenocarcinoma is a kind of extrahepatic tumor presentingmorphological areas identical to that of hepatocellular carcinomas.2.In addition to the histological similarity,it can also produceAFP-like hepatocellular carcino

5、masAmemiya et al.alpha-fetoprotein-producing gastric cancer(AFPGC)肝样胃癌的临床病理特征预后及研究展望80-90%Hcc患者血清AFP增高外院胃镜病理我院会诊意见：（胃窦小弯）腺癌Amemiya et al.部分肝硬化病人会长期出现AFP达到上千，但多年都没有肝癌的迹象。morphological areas identical to that of hepatocellular carcinomas.AFPPGC and HAS had more aggressive behavior and poorer prognosis

6、 than CGC.Concept of HAS!EXCEPTION!肝细胞癌Hcc90%Hepatoid adenocarcinoma of the stomach(HAS)Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.外院胃镜病理我院会诊意见：（胃窦小弯）腺癌alpha-fetoprotein-producing gastr

7、ic cancer(AFPPGC)Patients CharacteristicsNo Correlation Analysis我们科室我们科室AFPPGC与对照胃癌患者的总生存比较与对照胃癌患者的总生存比较肝样胃癌的临床病理特征预后及研究展望Amemiya et al.80-90%Hcc患者血清AFP增高80-90%Hcc患者血清AFP增高Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung

8、 carcinoma,and bladder cancer.Hepatoid adenocarcinoma of the stomach(HAS)Patients Characteristicsmorphological areas identical to that of hepatocellular carcinomas.外院胃镜病理我院会诊意见：（胃窦小弯）腺癌外院胃镜病理我院会诊意见：（胃窦小弯）腺癌In addition to the histological similarity,it can also produceSome reports showed that AFP cou

9、ld also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.（阳性率80-90%）AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.Can AFP be routinely checked in circular blood and gastric tissues by IHC?morphological a

10、reas identical to that of hepatocellular carcinomas.Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.!EXCEPTION!Hepatoid adenocarcinoma is a kind of extrahepatic tumor presenting49.2%11.5%75.

11、6%morphological areas identical to that of hepatocellular carcinomas.肝外胆管细胞癌Hcc10%AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.Amemiya et al.Some previous researches showed that the integrity of hepatocyte growth factor(HGF)receptor(c-Met)and ligand as HGF could regulate

12、 cell proliferation and migration.AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.It was proposed that some secretor

13、y proteins like AFP had immunosuppressive and protease-inhibitory properties,therefore enhanced invasiveness.AFP-like hepatocellular carcinomasmorphological areas identical to that of hepatocellular carcinomas.Some reports showed that AFP could also be produced by gastrointestinal tract organs,recta

14、l carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.随着病情的恢复，血清甲胎蛋白值会下降AFP也与病理类型相关，癌细胞分化I级和II级，AFP相对较低，级时相对较高。同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。肝样胃癌的临床病理特征预后及研究展望AFP in clinical use:外院胃镜病理我院会诊意见：（胃窦小弯）腺癌The exact molecular mechanism that could explain aggressive behavior was still not c

15、lear.Some previous researches showed that the integrity of hepatocyte growth factor(HGF)receptor(c-Met)and ligand as HGF could regulate cell proliferation and migration.Some previous researches showed that the integrity of hepatocyte growth factor(HGF)receptor(c-Met)and ligand as HGF could regulate

16、cell proliferation and migration.Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.HAS irrespective of AFP production

17、have a poorer prognosis than AFP-producing gastric carcinomas without hepatoid differentiationHAS should be distinguished from AFPPGC.ConclusionWhy:HAS means poor prognosis?v It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties,therefore enha

18、nced invasiveness.v The exact molecular mechanism that could explain aggressive behavior was still not clear.Some previous researches showed that the integrity of hepatocyte growth factor(HGF)receptor(c-Met)and ligand as HGF could regulate cell proliferation and migration.Amemiya et al.Found that c-

19、Met over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.These results suggested that aggressive behavior of AFP-producing gastric cancer may be associated with over-expressed c-Met.Target gene of poor biological behavior and easy

20、to liver metastasis?AFP in clinical use:v Can AFP be routinely checked in circular blood and gastric tissues by IHC?v Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.Patients Characteristic

21、s肝癌Found that c-Met over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.At present time,it was generally accepted that the diagnostic criteria of AFP-producing gastric cancer was positive staining of AFP in primary lesion regardle

22、ss of serum AFP level肝外胆管细胞癌Hcc10%外院胃镜病理我院会诊意见：（胃窦小弯）腺癌morphological areas identical to that of hepatocellular carcinomas.Target gene of poor biological behavior and easy to liver metastasis?肝样胃癌的临床病理特征预后及研究展望AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。alpha-fetoprotein-producing gastric cancer(AFPPGC)Patients Char

23、acteristicsAFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.!EXCEPTION!AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.Hepatoid adenocarcinoma of the stomach(HAS)alpha-fetoprotein-producing gastric cancer(AFPPGC)Amemiya et al.Some reports showed tha

24、t AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.Some previous researches showed that the integrity of hepatocyte growth factor(HGF)receptor(c-Met)and ligand as HGF could regulate cell proliferation and migration.（

25、阳性率80-90%）Amemiya et al.AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。随着病情恶化它在血清中的含量会急剧增加80-90%Hcc患者血清AFP增高Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.80-90%Hcc患者血清AFP增高AFP

26、与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。The exact molecular mechanism that could explain aggressive behavior was still not clear.Concept of HASmorphological areas identical to that of hepatocellular carcinomas.Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gal

27、lbladder carcinoma,lung carcinoma,and bladder cancer.alpha-fetoprotein-producing gastric cancer(AFPPGC)外院胃镜病理我院会诊意见：（胃窦小弯）腺癌!EXCEPTION!alpha-fetoprotein-producing gastric cancer(AFPPGC)morphological areas identical to that of hepatocellular carcinomas.At present time,it was generally accepted that t

28、he diagnostic criteria of AFP-producing gastric cancer was positive staining of AFP in primary lesion regardless of serum AFP level80-90%Hcc患者血清AFP增高!EXCEPTION!（阳性率80-90%）morphological areas identical to that of hepatocellular carcinomas.肝细胞癌Hcc90%These results suggested that aggressive behavior of

29、AFP-producing gastric cancer may be associated with over-expressed c-Met.alpha-fetoprotein-producing gastric cancer(AFPPGC)It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties,therefore enhanced invasiveness.AFPPGC and HAS had more aggressive

30、 behavior and poorer prognosis than CGC.Some reports showed that AFP could also be produced by gastrointestinal tract organs,rectal carcinoma,gallbladder carcinoma,lung carcinoma,and bladder cancer.（阳性率80-90%）AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.肝样胃癌的临床病理特征预后及研究展

31、望（阳性率80-90%）肝癌细胞AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.AFP-like hepatocellular carcinomasHepatoid adenocarcinoma is a kind of extrahepatic tumor presenting80-90%Hcc患者血清AFP增高Amemiya et al.One Case(ID:1204170)v Female,51yv 外院胃镜病理我院会诊意见：（胃窦小弯）腺癌v 术后病理（2010-5-25）：远端胃大部切除标本，IIc型，高-中分化腺癌，浸润至粘膜下层（早期胃癌），未见淋巴结转移（0/25），切缘阴性v AFPPGC(IHC)