肝樣胃癌的臨床病理特征預后及研究展望（優選）肝樣胃癌的臨床病理特征預后及研究展望新生幼稚肝細胞（未分化完全）分泌AFP量很大

肝癌細胞（尚未分化的肝細胞）80-90%Hcc患者血清AFP增高肝細胞癌Hcc—90%肝外膽管細胞癌Hcc—10%原發性肝癌甲胎蛋白是診斷原發性肝癌的一個特異性臨床指標。However!!EXCEPTION!!!!EXCEPTION!!部分肝硬化病人會長期出現AFP達到上千，但多年都沒有肝癌的跡象。同時發現約20%的晚期肝癌病人，直至病故前，AFP仍不超過10。

AFP與腫瘤大小有一定的相關性，即腫瘤越小，陽性率越低。AFP也與病理類型相關，癌細胞分化I級和II級，AFP相對較低，Ⅲ級時相對較高。SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.血清甲胎蛋白增高的原因

肝癌（陽性率80-90%）隨著病情惡化它在血清中的含量會急劇增加

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

生殖細胞腫瘤陽性率50%AFP陽性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診意見：（胃竇小彎）腺癌Amemiyaetal.部分肝硬化病人會長期出現AFP達到上千，但多年都沒有肝癌的跡象。morphologicalareasidenticaltothatofhepatocellularcarcinomas.AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.ConceptofHAS!!EXCEPTION!!肝細胞癌Hcc—90%Hepatoidadenocarcinomaofthestomach(HAS)SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.外院胃鏡病理我院會診意見：（胃竇小彎）腺癌alpha-fetoprotein-producinggastriccancer(AFPPGC)PatientsCharacteristicsNoCorrelationAnalysis我們科室AFPPGC與對照胃癌患者的總生存比較肝樣胃癌的臨床病理特征預后及研究展望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診意見：（胃竇小彎）腺癌外院胃鏡病理我院會診意見：（胃竇小彎）腺癌Inadditiontothehistologicalsimilarity,itcanalsoproduceSomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.（陽性率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，血清甲胎蛋白值會下降AFP也與病理類型相關，癌細胞分化I級和II級，AFP相對較低，Ⅲ級時相對較高。同時發現約20%的晚期肝癌病人，直至病故前，AFP仍不超過10。肝樣胃癌的臨床病理特征預后及研究展望AFPinclinicaluse:外院胃鏡病理我院會診意見：（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肝外膽管細胞癌Hcc—10%外院胃鏡病理我院會診意見：（胃竇小彎）腺癌morphologicalareasidenticaltothatofhepatocellularcarcinomas.Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?肝樣胃癌的臨床病理特征預后及研究展望AFP與腫瘤大小有一定的相關性，即腫瘤越小，陽性率越低。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.（陽性率80-90%）Amemiyaetal.AFP與腫瘤大小有一定的相關性，即腫瘤越小，陽性率越低。同時發現約20%的晚期肝癌病人，直至病故前，AFP仍不超過10。隨著病情惡化它在血清中的含量會急劇增加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性，即腫瘤越小，陽性率越低。Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.ConceptofHASmorphologicalareasidenticaltothatofhepatocellularcarcinomas.SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.alpha-fetoprotein-producinggastriccancer(AFPPGC)外院胃鏡病理我院會診意見：（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!!（陽性率80-90%）morphologicalareasidenticaltothatofhepatocellularcarcinomas.肝細胞癌Hcc—90%TheseresultssuggestedthataggressivebehaviorofAFP-producinggastricca