51例胃肠道间质瘤的临床和病理研究

Clinical,histological and immunohistochemical study of 51 cases of gastrointestinal stromal tumors

目的研究胃肠道间质瘤(GISTs)临床和病理形态特点及免疫组织化学在诊断中的价值,讨论肿瘤的组织来源、治疗和预后。方法对51例GISTs进行光镜观察,用SP免疫组织化学方法检测CD117(c-kit)、CD34、波形蛋白、actin、s-100等抗原标记物在肿瘤中的表达情况。结果51例GISTs,其中40例以梭形细胞为主;17例伴有上皮样细胞,4例单纯由上皮样细胞组成。免疫组织化学显示肿瘤组织中抗原标记物表达阳性率分别为CD11795.0%(48/51),CD3480.0%(41/51)。结论GISTs是消化道最常见的间叶性肿瘤,光镜形态与真性肌源性和神经源性肿瘤极为相似,免疫标记物配合使用可对其做作出正确诊断,GISTs可能起源于多潜能的间质干细胞。

Objective:To investigate the clinical and pathologic morphological features,immunohistochemical speciality of the gastrointestinal stromal tumors(GISTs) and their histogenesis,treatment and prognosis as well.Methods:The morphologic characteristics of GISTs were studied in 51 cases using light microscopy.The expression of c-kit(CDll7),CD34,vimentin,actin,S-100 were detected in all the cases with SP immunohistochemistry staining.Results:Among 51 cases of GISTs,40 were spindle cell type,4 epithelioid cell type and 17 mixturetype.Almost all of the stromal tumors were strongly positive for vimentin(99%),48 out of 51 tumors positive for CD117 (c-kit)(95.0 %) and 41 positive for CD34(78.5%).Some cases also expressed actin,S-100.Conclusion:GISTs are the most frequent mesenchymal tumor seen in the gastrointestinal tract.Under light microscope,the morphology of stromal tumors looks sometimes like that of a leiomyoma and Schwannoma.Application of immunohistochemical markers (particularly CD117 and CD34)is considered necessary for the differential diagnosis.GISTs may originate from the pluripotential stem cell of the interstium.