54例胃肠道间质瘤临床病理及免疫组织化学研究

A Clinicopathologic and Immunohistochemical Study on 54 Cases with Stromal Tumors in Gastrointestines

目的探讨胃肠道间质瘤（GIST）的临床病理组织形态学和免疫组织化学特点。方法用CD117和CD34等6种抗体，通过贫疫组化S-P法对发生于胃肠道的间叶源性肿瘤进行研究。确诊54例间质瘤，对其进行临床病理组织学和免疫组化分析。结果本组GIST共54例，发病年龄为32-75岁，中位年龄54岁。临床表现为腹痛、腹胀及发现腹部包块等。大体形态上GISTs肿块可单发或多发，体积大小不等，可见出血、坏死及囊性变。镜下GISTs瘤细胞形态主要为梭形和上皮样形，大部分梭形瘤细胞排列呈束状或交织状，灶性可呈车辐状、栅栏状及围绕血管呈器官样排列。本研究54例肿瘤中梭形细胞型28例（51．8％），上皮样细胞型9例〈16．7％），混合型17例（31．5％）。38例（70．3％）出现交叉束状排列，30例（55．6％）出现弥漫片状或巢状排列，18例（33．3％）出现栅栏状排列，16例（29．6％）围绕血管呈器官样，31例（57．4％）同时具有多种排列结构。免疫组化显示54例GIST中CD117阳性表达率为92．6％，CD34的阳性表达率为77．8％；Aetin与S-100阳性瘤细胞大部分为散在或小灶状分布，Desmin均为阴性表达。结论GIST多发于中老年。肿瘤细胞形态多样，结构多样；免疫组化CD117和CD34阳性表达是确诊间质瘤最有诊断价值的依据，但间质瘤良、恶性诊断上仍需结合肿瘤的大体、组织学形态及生物学行为等综合考虑。

Objeetive To study the clinicopathologic and immunohistochemical features of gastrointestinal stromal tumors （GISTs）. Methods Fifty four cases with primary stromal tumors were distinguished from the group of mesenchymal tumors by use of a panel of antibodies such as CD117, CD34 by immunohistochemical S-P method, their biological behaviors were analyzed. Results All the patients were adults. Age range from 32 to 75 years （mean 54 years）. The most common symptoms were abdomen mass and vague pain. Grossly, they were of soft consistency often with hemorrhage, cystification or necrosis. Microscopically the tumors were composed of spindle cells or epithelioid cells and of both cells , arranged in interlacing fasicles, diffusing sheets, pallisading, whirling, alverlar and giant pseudo-rosette shapes. Among 54 cases with GISTs, the positive rates of CD117 and CD34 were 92.6% and 77.8% respectively. Few tumor cells were positive mark in Actin and S-100 and Desmin was negative in all tumor cells.Conclusions CDll7 and CD34 positivties are the most valuable factors in diagnosing stromal tumors. It is essential to distinguish the potential malignant parameters in stromal tumors according to their morphologic characters and biologic behaviors.