22例胃肠道间质瘤临床病理及免疫组织化学分析

Analysis of the clinicopathology and immunhistochemistry on 22 gastrointestinal stromal tumors

目的 探讨胃肠道间质瘤 (GIST)的组织病理形态学和免疫组织化学特点。方法 用CD117、CD34、SMA、Desmin、S 10 0蛋白质抗体通过免疫组织化学SP法对原发性GIST进行研究。结果 本组GIST发病年龄在 12～ 78岁(平均 5 5岁 ) ,男性 7,女性 15例 ,主要发生在胃并常常以上消化道出血为首发症状 ,大多数病例为手术切除后标本确诊。肿瘤大小从 0 5～ 16cm(平均为 5 31cm)。基本组织形态为梭形细胞和上皮样细胞。大部分梭形细胞界线不清楚、胞浆丰富、偶见多核巨细胞 ,部分病例见核端空泡 ,梭形细胞呈交叉束状、旋涡状、席纹状排列 ;上皮样细胞可透明、细胞界线更清楚 ,多呈弥漫片状或巢状排列。可以伴有囊性变、粘液变、出血及坏死。核分裂像大于 5 / 5 0HPF的 5例中肿瘤直径均在大于或等于 5cm ,其中 4例伴有囊性 ,出血或坏死 ,1例伴有粘液样变性。 2例核分裂像在 2～ 5 / 5 0HPF均为上皮样细胞型 ,其中一例伴有粘液样变 ,肿瘤直径均在 2～ 4cm之间。免疫组化染色CD117和CD34多为弥漫强阳性 ,阳性率分别为 95 5 %和 6 8 2 %。Desmin不表达 ,S 10 0蛋白质和SMA不表达或者呈灶状阳性。结论 GIST好发生在中老年 ,肿瘤细胞形态多变和排列方式多样 ,免疫组织化学染色为CD117、CD34阳性、Desmin阴性 ,S 10 0蛋?

Objective To explore the histopathological and immunohistochemical feature of gastrointestinal tumors. Methods Immunohistochemical staining were performed in the primary gastrointestinal tumors for a panel of antibodies such as CD117, CD34 SMA, Desmin, S 100 by SP methods. Results The patient’s ages ranged from 12 yeas to 78 years(mean 55yeas) including 7 male and 15 female. The tumors mainly were located in the stomach with the initial presentation of gastrointestinal bleeding in the most cases. The most cases were diagnosed after surgical resection. Tumor size varied from 0 5 cm to 16 cm(mean 5 31 cm). The primary cell morphology consisted of spindle shaped cells and epithelioid cells. Within tumors, composed of primarily spindle shaped cells, the cellular borders were not clearly defined, cytoplasm was abundant and multinucleation may be seen occasionally. The alveolar in the end of nuclear may be seen in some cases. The spindle shaped cells arranged in fascicular, whorled, and storiform; The epithelioid cells may be clear and cellular border were more clearly defined and they arranged in diffusing sheets or“nest” appearance. Cystification, mucification hemorrhage or necrosis may be present. The mitotic count was higher than 5/50HPF in 5 cases which were over or equal 5cm in diameter with cystification heamorrage or necrosis in 4 cases and musication in 1 case. The mitotic count was 2-5/50HPF in 2 cases, which were epithelioid cell, and tumor sizes were 2-4 cm in diameter with mucification in a case. Immunohistochemically, CD117 and CD34 showed diffuse strong expression, the positive rates were 95 5% and 68 2% respectively. Desmin was almost never present, S 100 protein and SMA were focally present or absent. Conclusion GISTs predominantly occurred in middle aged or older patients, with various kinds of cell types and different arrangements. Immunohistochemical staining was positive for CD117 and CD34, negative for desmin, focal positive or absent for S 100 protein and SMA. The tumors are over or equal 5 cm in diameter, mitotic count is over 5/50HPF, hemorrhage or necrosis might help to identify tumors with malignant potential.