胃间质瘤超声内镜检查及免疫组织化学检测的临床意义

Endoscopic Ultrasonography and Immunohistochemistry of Gastric Stromal Tumors

目的探讨超声内镜及免疫组织化学检测对胃间质瘤(GST)良恶性评估的意义。方法回顾性分析经胃镜及超声内镜发现的胃黏膜下肿物112例,其中经内镜下切除和手术治疗的32例进行病理组织学及免疫组织化学检查(Ki-67,p53,CD34,CD117),并分析超声内镜图像(包括大小、层次、回声、有否液性暗区及分叶、边缘的声晕、倍增时间等)。结果(1)CD117和CD34在GST中的表达率分别为90.6%和81.3%;(2)Ki-67在危险度低、中、高组表达分别为7.8%,27.3%,87.5%,危险度低组与高组之间差别有统计学意义(P<0.05);p53在危险度低、中、高组表达分别为0%,18.2%,68.5%,危险度低组与高组之间差别有统计学意义(P<0.05);(3)13例恶性GST具有以下特征:长径>4 cm,呈分叶、内部回声不均匀、液性暗区、边缘不规则伴有声晕、较短的倍增时间。结论超声内镜可为临床治疗和预后评估提供参考。CD117、CD34可作为GST的免疫组织化学标志物;Ki-67,p53的检测有助于GST恶性程度的判断。

Objective This study was performed to evaluate the need of following up and treatment of gastric stromal tumors(GST) by endoscopic ultrasonography(EUS) and immunohistochemistry.Methods This study was performed on 112 patients who had GST on endoscopy and EUS.32 patients of them were treated under endoscopy or surgery and confirmed by histologic examinations using immunohistochemical between January 2004 and June 2006 at our hospital.We evaluated the clinical features,EUS findings(size,layer,echogenicity,cystic liquid dark area,et al) and immunohistochemical stain(CD117,CD34,Ki-67,p53).Results(1)CD34 and CD117 of GST were 90.6 and 81.3;(2)Ki-67 expressed in GIST of malignant low,middle and high groups separationaly 7.8%,27.3%,87.5%,and there had significant different in malignant low and high groups;Ki-67 expressed in GIST of malignant low,middle and high groups separationaly 0,18.2%,68.5%,and there had significant different in malignant low and high groups;(3) The appearance of EUS of GST(diameter>4 cm,cystic change,lobuation) prognosticated its invasion.Conclusion CD117 and CD34 may be the immunohistochemistry marker of GST.(Ki-67) and p53 used to be favor for judging of malignant.EUS would be helpful to evaluate the risk of aggressive behavior of GST.