胃肠道间质肿瘤临床病理分析

A clinicpathological study and new developments in gastrointestinal stromal tumor

目的:探讨胃肠道间质肿瘤(GIST)的临床病理、免疫组化特征及其研究进展。方法:分析179例GIST患者的临床资料,观察其病理组织HE及免疫组化特性。结果:GIST可发生于整个胃肠道,多发生于胃和小肠,179例GIST患者中发生于胃部为88例(49.2%),小肠67例(37.4%)。病理观察,GIST由梭形细胞及上皮样细胞构成,免疫组化染色C-kit蛋白(CD117)阳性率为100%(179/179),原始造血干细胞抗原(CD34)阳性率为65.9%(118/179),干蛋白(nestin)阳性率为76.0%(38/50),部分病例平滑肌肌动蛋白(SMA)、S-100蛋白(S-100)、结蛋白(desmin)为阳性。结论:不同于胃肠道其他间叶源性肿瘤,GIST的分子生物学机制为原癌基因c-kit突变,免疫组化CD117、CD34、nestin表达阳性是其最具价值的依据诊断。

Objective To study the clinical pathological and immunohistochemical characteristics of gastrointestinal stromal tumor （GIST） and its research progress. Methods The clinical presentation, histological features and immunohistochemical characteristics were studied in 179 cases of GIST. Results GIST could occur in the whole gastrointestinal tract, especially in stomach and small intestine. Of the 179 cases presented, 88 cases （49.2%） occurred in stomach and 67 cases（37.4%） occurred in small intestine. Pathologically it was composed of spindle cells and epithelioid cells, Immunohistochemically, 100%（179/179）cases expressed c-kit protein （CD117）, 65.9%（118/179）expressed hematopoietic stem cell antigen （CD34）, 76.0%（38/50）expressed nestin, and some expressed smooth muscle actin （SMA）,S-100 and desmin. Conclusions GIST are different from other gastrointestinal mesenchmal neoplasms, of which the molecular biological mechanism is the mutation of protooncogene c-kit. Expressions of CD117, CD34 and nestin are most valuable for identifying GIST.