胃肠道间质细胞瘤的临床特点与鉴别诊断

Clinical features and differential diagnosis of gastrointestinal stromal tumor

目的探讨胃肠道间质细胞瘤(GISTs)的临床特点、良恶性差异及免疫组化特征,以提高其诊断及鉴别诊断水平。方法22例GISTs进行临床、病理及免疫组织化学分析。结果肿瘤位置:胃8例,小肠11例,肠系膜2例,结肠1例。肿瘤大小:长径<5 cm 13例,≥5 cm 9例。病理诊断:胃间质细胞瘤7例,胃恶性间质细胞瘤1例,小肠间质细胞瘤4例,小肠恶性间质细胞瘤7例,肠系膜恶性间质细胞瘤2例,结肠间质细胞瘤1例。免疫组织化学:CD117+^+++20例(90.9%)、CD34+^+++17例(77.3%)、S-100-22例(100%)、Action+7例(31.8%)、Desmin±1例(4.5%)。结论GISTs临床诊断较困难,常需参考各项诊断指标,相应的症状与体征结合影像学检查可提供GISTs病变部位、范围与周围组织的关系,而肿瘤大小、有无浸润与转移及核分裂相计数可判定其良恶性,免疫组织化学可与其他间叶肿瘤进行鉴别。

Objective To analyze the clinical and pathological features, immunohistochemical speciality of gastrointestinal stromal tumor（GISTs）. Methods The clinical and imaging features of GISTs were studied in 22 cases and their morphologie characteristics and expression of CD117, CD34, Action ,desmin, S - 100 were detected with SP immunohistoehemieal staining. Results Among 22 cases of GISTs,8 were located in stomach, 11 in small intestine,2 in epiploon, 1 in colon. They were divided into 12 benign, 6 potential malignant and 4 malignant with morphologic determinant. 20 out of 22 GISTs positive for CD117 （90.9%）, 17 positive for CD34 （77.3%）, and some cases also expressed Action （31.8% ）. Conclusion It is difficult to diagnose correctly the GISTs before operation and juade the benign and malignant tumor in the process of operation ,application of immunohistochemical markers is considered necessary for the differential diagnosis.