肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件

Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,肝样胃癌的临床病理特征预后及研究展望,肝样胃癌的临床病理特征预后及研究展望,1,（优选）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研究展望,2,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,）,新生幼稚肝细胞分泌AFP量很大,3,80-90%,Hcc,患者血清,AFP,增高,肝细胞癌,Hcc90%,肝外胆管细胞癌,Hcc10%,原发性肝癌,80-90%Hcc患者血清AFP增高肝细胞癌Hcc90%肝,4,甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。,However,!EXCEPTION!,甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。 Howeve,5,!EXCEPTION!,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。,同时发现约,20%,的晚期肝癌病人，直至病故前，,AFP,仍不超过,10,。,AFP,与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。,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。,Some reports showed that AFP could also be produced by,gastrointestinal tract organs, rectal carcinoma, gallbladder carcinoma, lung carcinoma, and bladder cancer.,!EXCEPTION!部分肝硬化病人会长期出现AFP达到,6,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,慢性肝炎,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，血清甲胎蛋白值会,下降,生殖细胞肿瘤,阳性率,50%,AFP,阳性,血清甲胎蛋白增高的原因,7,alpha-fetoprotein-producing gastric cancer (AFPGC),Hepatoid adenocarcinoma of the stomach (HAS),alpha-fetoprotein-producing ga,8,Concept of HAS,Why: HAS means poor prognosis?,肝样胃癌的临床病理特征预后及研究展望,Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?,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,肝细胞癌Hcc90%,Found that c-Met over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.,（优选）肝样胃癌的临床病理特征预后及研究展望,肝细胞癌Hcc90%,!EXCEPTION!,Patients Characteristics,随着病情的恢复，血清甲胎蛋白值会下降,Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?,血清甲胎蛋白增高的原因,AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。,In addition to the histological similarity, it can also produce,Why: HAS means poor prognosis?,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 of AFP in primary lesion regardless of serum AFP level,Concept of HASConcept:At prese,9,Concept,of HAS,1. Hepatoid adenocarcinoma is a kind of extrahepatic tumor presenting,morphological areas identical to that of hepatocellular carcinomas.,2. In addition to the histological similarity, it can also produce,AFP-like hepatocellular carcinomas,Concept of HAS 1. Hepatoid ade,10,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,11,Patients Characteristics,Patients Characteristics,12,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,13,No Correlation Analysis,No Correlation Analysis,14,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,15,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。,肝癌,肝癌,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,Amemiya et al.,HAS irrespective of AFP production have a poorer prognosis than AFP-producing gastric carcinomas without hepatoid differentiationHAS should be distinguished from AFPPGC.,It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties, therefore enhanced invasiveness.,Target gene of poor biological behavior and easy to liver metastasis?,Target gene of poor biological behavior and easy to liver metastasis?,同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。,alpha-fetoprotein-producing gastric cancer (AFPPGC),One Case (ID:1204170),At present time, it was generally accepted that the diagnostic criteria of AFP-producing gastric cancer was positive staining of AFP in primary lesion regardless of serum AFP level,Concept of HAS,!EXCEPTION!,随着病情的恢复，血清甲胎蛋白值会下降,肝癌,One Case (ID:1204170),The exact molecular mechanism that could explain aggressive behavior was still not clear.,Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?,我们科室,AFPPGC,与对照胃癌患者的总生存比较,AFP也与病理类型相关，癌细胞分化I级和II级，AFP相对较,16,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,17,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,18,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,19,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,20,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,21,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,22,49.2%,11.5%,75.6%,49.2%11.5%75.6%,23,肝样胃癌的临床病理特征预后及研究展望ppt优质案例课件,24,AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC.,HAS irrespective of AFP production have a poorer prognosis than AFP-producing gastric carcinomas without hepatoid differentiationHAS should be distinguished from AFPPGC.,Conclusion,AFPPGC and HAS had more aggres,25,Why: HAS means poor prognosis?,It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties, therefore enhanced invasiveness.,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-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 to liver metastasis?,Why: HAS means poor prognosis?,26,AFP in clinical use:,Can AFP be routinely checked in circular blood and gastric tissues by IHC?,Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?,AFP in clinical use: Can AFP,27,外院胃镜病理我院会诊意见：（胃窦小弯）腺癌,血清甲胎蛋白增高的原因,It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties, therefore enhanced invasiveness.,alpha-fetoprotein-producing gastric cancer (AFPGC),Found that c-Met over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.,One Case (ID:1204170),Hepatoid adenocarcinoma of the stomach (HAS),我们科室AFPPGC与对照胃癌患者的总生存比较,HAS irrespective of AFP production have a poorer prognosis than AFP-producing gastric carcinomas without hepatoid differentiationHAS should be distinguished from AFPPGC.,It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties, therefore enhanced invasiveness.,肝外胆管细胞癌Hcc10%,No Correlation Analysis,Target gene of poor biological behavior and easy to liver metastasis?,alpha-fetoprotein-producing gastric cancer (AFPGC),80-90%Hcc患者血清AFP增高,肝癌细胞,Hepatoid adenocarcinoma is a kind of extrahepatic tumor presenting,AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。,Hepatoid adenocarcinoma of the stomach (HAS),One Case (ID:1204170),血清甲胎蛋白增高的原因,随着病情恶化它在血清中的含量会急剧增加,Amemiya et al.,肝外胆管细胞癌Hcc10%,甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。,Hepatoid adenocarcinoma is a kind of extrahepatic tumor presenting,alpha-fetoprotein-producing gastric cancer (AFPPGC),AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。,Concept of HAS,alpha-fetoprotein-producing gastric cancer (AFPGC),肝细胞癌Hcc90%,Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?,At present time, it was generally accepted that the diagnostic criteria of AFP-producing gastric cancer was positive staining of AFP in primary lesion regardless of serum AFP level,Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?,!EXCEPTION!,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.,Amemiya et al.,（优选）肝样胃癌的临床病理特征预后及研究展望,One Case (ID:1204170),Female, 51y,外院胃镜病理我院会诊意见：（胃窦小弯）腺癌,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,AFPPGC (IHC),外院胃镜病理我院会诊意见：（胃窦小弯）腺癌Hepatoid,28,