肝转移性胃肠道间质瘤临床病理分析15例

Clinicopathological analysis of hepatic metastatic gastrointestinal stromal tumors:an analysis of 15 cases

目的:探讨肝转移性胃肠道间质瘤(GISTs)的临床病理、免疫组化特点.方法:复习文献,分析15例肝转移性GISTs的临床表现、组织学及免疫组化特征.结果:本组15例肝转移性GISTs,原发灶分别位于小肠(6例)、胃(5例)及网膜(2例),余2例来源不明.发现肝转移灶与原发肿瘤手术相距时间为0 d-86 mo(平均25 mo±9 mo).肿瘤大小为1.5-30.0(平均7.1±1.2)cm.6例伴有出血、坏死或囊性变.组织学分型:梭形细胞型11例,上皮样细胞型2例,混合型2例.免疫组化结果:肿瘤细胞弥漫表达CD117(86.7%)、CD34(46.7%),灶性表达SMA(33.3%)、S-100(20%),Desmin均为阴性.结论:肝脏是GISTS最常见的转移部位,原发部位多为小肠和胃.其临床表现、组织形态及免疫组化表型与原发灶基本一致.预后较差.CD117和CD34联合应用有助于鉴别诊断.

AIM： To study the clinicopathological and immunophenotypical features of hepatic metastatic gastrointestinal stromal tumors （GISTs）. METHODS： Clinical and pathological data of 15 patients with hepatic metastatic GISTs were analyzed, and the related literature was reviewed. RESULTS： The tumors mainly originated from the small bowel （6/15） and stomach （5/15）. The length of time after surgical treatment of the primary tumor to detection of a hepatic metastatic tumor was 0 d-86 mo （mean 25mo±9mo）. Tu- mor size varied from 1.5 cm to 30.0 cm （mean 7.1 cm±1.2 cm）. Cystification, hemorrhage or necrosis was observed in 6 tumors. Histologically, 11 were of the spindle cell type, 2 the epithelioid cell type and 2 mixture type. CD117 and CD34 showed diffuse expression, with a positive rate of 86.7% and 46.7%, respectively. Some cases were focally positive for SMA （33.3%） and S-100（20%）. Desmin was negative in all the 15 tumors CONCLUSION： The liver is the most metastatic site of GISTs. The most common primary sites of hepatic metastatic GISTs are the small bowel and stomach. Hepatic metastatic GISTs have similar clinical and pathological features as primary GISTs, and a poor prognosis. The combination of CDl17 and CD34 is helpful for differential di- agnosis.