위암에 동반된 원발성 융모막암종과 간세포양암종
A Case of Gastric Undifferentiated Carcinoma with Choriocarcinomatous and Hepatoid Carcinomatous Differentiation
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초록
62세 남자가 건강검진으로 내시경 검사를 시행 받은 후 진행성위암으로 진단을 받았다. 수술 전 조직검사에서 중등도 분화도의 위선암으로 진단을 받고, 원격전이가 없어서 근치적 위 아전절제술을 시행 받았다. 수술 후 조직병리에서 융모막암종과 간세포양암종이 동반된 미분화암으로 진단되었다. 항암치료를 시행하였으나, 수술 후 5개월 째 간 전이가 발생하였고, 치료에 반응이 없어서 진단 후 11개월 째 간기능 악화 및 폐렴으로 사망하였다. 위암에 원발성 융모막암종과 간세포양암종이 동시에 발생하는 증례는 매우 드물어 문헌 고찰과 함께 보고한다.
Abstract
Here we report a case of a patient with gastric undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. A 62-year-old man was referred after a healthcare screening gastroscopy. Gastroscopy revealed an approximately 3×3 cm ulcerofungating mass in the posterior wall of the antrum. Biopsy results revealed a moderately differentiated adenocarcinoma. The initial serum α-FP levels were above 350 ng/mL. An abdominal CT scan revealed focal wall thickening along the greater curvature of the gastric antrum, with perigastric fat invasion and enlarged multiple perigastric lymph nodes. He underwent a palliative radical subtotal gastrectomy and gastroduodenostomy with dissection of the enlarged lymph nodes. Postsurgical histological examination revealed an undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. Immunohistochemical staining revealed that the tumor cells were positive for human chorionic gonadotropin (hCG), α-FP, and anti-hepatocyte antibody.
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