上消化道间叶源性肿瘤临床病理特征46例

Clinical and pathological characteristics of upper gastrointestinal mesenchymal tumors:An analysis of 46 cases

目的:观察上消化道间叶源性肿瘤(GIMTs)的临床病理及免疫组化特征,探讨其临床诊断及处置策略.方法:46例内镜超声检查拟诊为上消化道间质瘤的病例,采用光镜观察其手术或黏膜切除术(EMR)标本的病理特征,免疫组化检测其CD117,CD34,平滑肌抗体(SMA)和S-100的表达状况,并分析其病理诊断与临床的关系.结果:46例GIMTs中食管肿瘤占24例,其中间质瘤5例(20.8%),平滑肌瘤19例(79.2%);22例胃GIMTs中间质瘤20例(90.9%),平滑肌瘤1例,神经鞘瘤1例.25例上消化道间质瘤中CD117阳性21例(84%)、CD34阳性24例(96%).而平滑肌瘤与神经鞘瘤分别仅表达SMA和S-100.结论:上消化道间叶源性肿瘤光镜下病理特征相似,联合检测CD117,CD34,SMA和S-100等免疫组化标记物可区别上消化道GIMTs.在食管以平滑肌瘤多见;而在胃则以间质瘤多见,平滑肌瘤与神经鞘瘤非常少见.

AIM： To study the clinical, pathological and immunohistochemical characteristics of upper gastrointestinal mesenchymal tumors （GIMTs）, so as to provide guidance for clinical diagnosis and treatment. METHODS： Forty-six cases of upper GIMT were clinically diagnosed by endoscopic ultrasonography （EUS）. The samples obtained by surgery or endoscopic mucosal resection were observed by pathological sectioning and staining. The expression of CD117, CD34, smooth muscle antibodies （SMA） and S-100 was assayed by immunohistochemical staining. RESULTS： Twenty-four of the 46 GIMTs were esophagus mesenchymal tumors, 5 of which were stromal tumors （20.8%） and 19 were leiomyomas （79.2%）. Twenty-two of the 46 tumors were gastric mesenchymal tumors, which included 20 stromal tumors （90.9%）, 1 leiomyoma and 1 neurilemmoma. Twenty-one of the 25 upper gastrointestinal stromal tumors were CD117 positive （84%） and 24 were CD34 positive （84%）, SMA and S-100 were expressed only in leiomyoma and neurilemmoma, respectively. CONCLUSION： The pathological characteristics of upper GIMTs are similar by microscopic observation, and can be differentiated by combined assay of some immunohistochemical markers such as CD117, CD34, SMA and S-100. Most esophagus mesenchymal tumors are leiomyomas, and most gastric mesenchymal tumors are stromal tumors. Leiomyoma and neurilemmoma are rare.