胃肠道间质瘤19例临床病理分析

Clinicopathologic study on 19 cases of gastrointestinal stromal tumors

目的:探讨胃肠道间质瘤(gastrointestinalstromaltumors,GIST)的临床病理、免疫组化特征、鉴别诊断和治疗方法。方法:应用光镜观察形态特征,应用免疫组化SP法对胃肠道和胃肠外腹腔内原诊断为平滑肌瘤、平滑肌母细胞瘤和平滑肌肉瘤24例检测CD117、CD34、Vimentin、SMA和S100,获得19例GIST。结果:19例GIST占同期消化系统间叶肿瘤的79.2%(19/24)。抗体表达情况:CD11794.7%(18/19)、CD3463.2%(12/19)、Vimentin100%(19/19)、SMA15.8%(3/19)阳性和S100表达全部阴性。结论:GIST是消化道最常见的间叶性肿瘤。CD117、CD34、SMA和S100联合使用可协助鉴别诊断GIST。细胞密集、明显核异形、肿瘤性坏死以及核分裂数>5/50HP可作为恶性参考指标,手术切除是主要的治疗方式。

OBJECTIVE：To study clinicopathology and immunohistochemical features of gastrointestinal stromal tumors （GISTs）, and their differential diagnosis and treatment. METHODS： The dinicopathologic characteristics of GISTs were studied by using light microscopy （a panel of antibodies such as CD117 ,CD34 ,Vimentin,SMA,and S- 100 protein were detected by SP in 24 cases）, which were previously diagnosed as leiomyoma, leiomyoblastoma, or leiomyosarcoma etc. RESULTS： Nineteen cases of GIST were equivalent to 79.2% （19/24） of all mesenchymal tumors of gastrointestinal tract in the same period. Tumors expressed CD117 94. 7 % （18/19）, CDu 63.2% （12/19）, Vimentin100%（19/19）, SMA15. 8% （3/19）, S-100（0/19）. CONCLUSIONS： GIST is the most frequent mesenchymal tumor of gastrointestinal tract. Application of immunohistochemical markers （ CD117, CD34, SMA and S-100 ） contribute to differential diagnosis. High cellularity, obvious nuclear atypia,tumor coagulative necrosis and mitoses over 5/50HP are malignant parameters. Surgical resection is mainly treatment.