87例胃肠道间质瘤的病理学分析及临床诊治

The pathology, clinical diagnosis and treatment of gastrointestinal stromal tumor

目的:总结胃肠道间质瘤(GIST)的病理学分析和临床诊疗经验。方法:通过免疫组织化学Envision法确诊87例GIST并分析其病理特征、免疫表型、临床表现及影像学检查。结果:位于胃者59例(67.8%),小肠23例(26.4%),结肠1例(1.1%),其他部位(系膜、网膜及后腹膜)4例(4.6%)。87例GIST的免疫组化染色显示,波形蛋白阳性者为87例(100%),CD117 87例(100%),CD34 75例(86.2%),SMA 11例(12.6%),结蛋白8例(9.2%),S-10017例(19.5%),NSE 13例(14.9%)。诊断为良性GIST者11例(12.6%),潜在恶性18例(20.7%),低度恶性28例(32.2%),高度恶性30例(34.5%)。总的随访率为76/87(87.4%)。通过病史及随访发现复发或转移的病例共12例(13.8%)。所有病例均接受了手术治疗,其中3例有术后复发/转移的病人接受了格列卫治疗。结论:GIST的确诊主要依靠病理学观察及免疫组化检测,CD117是诊断GIST的重要标记物。肿瘤大小和细胞核分裂数是判断良、恶性GIST的重要指标。手术完整切除肿瘤是治疗GIST的关键;甲磺酸伊马替尼对治疗无法切除或者复发/转移的恶性GIST能取得一定的疗效。对GIST病人术后的长期随访是必要的。

Objective To review the pathologieal analysis, clinical diagnosis and surgical treatment of gastrointestinal stronlal tumor（GIST）. Methods A total of 87 cases were detected by the Etlvision inmmnohistochemical method, and were diagnosed as GIST. The pathological features, ilnnlunohistochemical phenotypes, clinical manifestations and imaging findings were analvzed. Results Of all the GIST examined. 59 eases were located in the stomacll （67.8 %）, 23 in the small intestine （26.4 %）. 1 in the colon （1.1%） and 4 in other sites including the mesentery, omentum and retroperitoniunl 14.6 %）. All of tile 87 cases were positive for vimentin （87/87. 100 %）. 87 cases fur CD117 （87 /87. 100 %）. 75 cases for CD34 （75/87. 86.2 %）. 11 eases for SMA （11/87, 12.6 %）. 8 cases for desmin （8/87. 9.2 %）. 17 cases for S-100 （17/87, 19.5 %） and 13 eases for NSE （13/87, 14.9%）. Eleven casts were diagnosed as benign （12.6%）, 18 potentially malignant （20.7 %）. 28 of low malignancy （32.2%） and 30 of high malignancy （34.5 %）. Seventy six cases were successfully followedup（87.4%）, and 12 cases （13.8%） were confirmed to have rectnTenee or metastasis. All the patients were submitted to operation, and 3 wlto hed subsequently metastasis or recurrence were treated with ilnatinib mesylate. Conclusions The diagnosis of GIST depends （711 pathological and immunohistoehelnical exalninations. CD117 is the most important marker for the diagnosis of GIST. The size of the tunlor and the lnitotic frequeney of the cells are crucial for the differentiation between benign and malignant tumors. Surgical resection is the treatlnent of choice for GIST. Imatinib mesylate has shown high efficacy for the treatment of patients with umresectable or lnetastatic GIST. Long-term follow-up of the GIST patients should be carried out.