空回肠交界处巨大憩室恶性间质瘤临床病理观察

Gastrointestinal malignant stromal tumors(GIST) in a large diverticulum of jejunum-ileumin junction:a clinicopathological observation

目的探讨小肠憩室恶性间质瘤的影像学和临床病理学特征。方法对1例小肠憩室恶性间质瘤进行影像学、临床病理及免疫组化观察,并进行文献复习。结果患者男性,33岁。手术标本呈囊实性,与肠腔相通。组织形态镜下瘤细胞主要由梭形和少许上皮样细胞组成。梭形瘤细胞排列呈束状、编织状、栅栏状;上皮样瘤细胞呈小巢片状分布在梭形瘤细胞之间。免疫组化CD117、CD34、S-100、desmin、SMA和NSE均为(+)。结论胃肠间质瘤(GIST)可发生于从食管至肛门的胃肠道全长范围内,但是小肠憩室伴发恶性间质瘤十分罕见,临床症状无特殊规律性,极易误诊,诊断有赖于影像学、临床病理和最具特征的免疫组化检查。

Objective To investigate the clinicopathologic and radiological characteristics of the gastrointestinal stromal tumors （GIST） in a small intestine diverticulum. Methods The clinicopathologic and radiological changes and immunohistochemical findings were observed in one case of GIST in the small intestine diverticulum, with review of the relevant literature. Results The patient was a 33-year-old man who developed abdominal pain for one year, aggravated with black stools for one day. Computered tomographic scan showed a large cystic-solid mass in the lower abdominal cavity. The sample was cystic and solid communicating with the intestinal cavity. The tumor cells were composed of many spindle cells and few epithelioid cells. The histological component of the spindle ceils included interlacing fascicles and palisading pattern. The epithelioid cells were distributed among the spindle cells with nest cluster shape. Immunohistochemical staining showed that the tumor cells were positive for CD117, CD34, S-100, desmin, SMA and NSE. Conclusion The GIST often occurs in alimentary tract from oesophagus to anus, but rarely in the small intestine diverticulum. The clinical symptom has no a special role and is easily being misdiagnozed. The diagnosis is mainly based on radiology, pathology and immunohistochemistry.