胃肠道间质瘤的临床诊治及病理免疫组化分析

To Analysis the Diagnosis,Therapy and Immunohistochemical Features of Gastrointestinal Stromal Tumors

目的探讨胃肠道间质瘤(GISTs)的临床诊治方法及病理免疫组化特征。方法对我院2003年8月至2006年6月经手术及病理证实为GISTs的26例病例作回顾性分析。用免疫组化SP法检测CD117、CD34、Vimentin、desmin及S-100等5种抗体的表达情况。结果26例GISTs中,胃12例,占46.2%;小肠10例,占38.5%;食管1例,占3.8%;直肠2例,占7.7%;肠系膜1例,占3.8%。其中良性9例(9/26),低度恶性9例(9/26),恶性8例(8/26)。位于小肠者均为交界性及恶性,其恶性度与其它部位的肿瘤相比差异有显著性(P<0.05),良、恶性间质瘤的大小比较差异有显著性(P<0.05)。术前诊断GISTs仅3例,术前诊断率为11.5%,多误诊为胃癌、平滑肌瘤等。CD117、CD34、Vimentin、desmin及S-100阳性率分别为92%(24/26)、88%(23/26)、100%(26/26)、4%(1/26)、12%(3/26)。结论GISTs可发生于任何年龄,但多见于50岁以上的中老年人。GISTs可发生在从食管到直肠的消化道的任何部位,主要发生在胃和小肠,肿瘤发生部位和大小与肿瘤良恶性密切相关。GISTs术前诊断较困难,CD117和CD34在间质瘤的诊断中具有重要价值。

Objective To probe the clinical methods about diagnosis,therapy and immunohistochemical features of gastrointestinal stromal tumors（GISTs）. Methods The clinicopathological date of operated 26 patiens with GISTs were analyzed retrospectively. Te expressions of CD 117, CD 34,Vimentin, desmin and S-100 were detected by immunohistochemical S-P method. Results In 26 cases of GISTs, the tumors were situated in stomach（ 12 cases） ,in small intestine（ 10 cases） ,in rectum（2 cases）,in esophagus（ 1 case） and in mesenterium（ 1 case）. 9 cases were benign ,9 cases potential malignanat and 8 cases malignant All GISTs lying on small intestine were potential malignant or malignant and their malignant degree were significantly higher（ P 〈0. 05） than the tumor on other digestive tract. In cases of potential malignant and malignant tumors,the tumor size were nntieeable that have signifieantly different（ P 〈0. 05） as comparing with the benign. There were only 3 eases whieh had been diagnosed before operation,and the diagnosis rate was 11.5 percent. Most of them were diagnosed wrongly as gastric cancer,liomyoma and so on. The positive rates of CD 117 ,CD 34,Vimentin,desmin and S-100 in 26 cases were 92% （24/26） ,88% （23/26） ,100% （26/26） ,4% （1/26） ,12% （3/26）. Con-clusion GISTs are favorable occurrence in middle-aged. GISTs can occupy in any place of digestive tract from esophagus to rectum. GISTs seem to occur most frequently at stomach and small intestine. Malignant degree of tumor correlates intimately with occurrence site and tumor size. It is difficult to diagnose GISTs before operation for their clinical symptoms have no special signs. CD 117 and CD 34 have important significance in diagnosis and differential diagnosis of GISTs.