35例胃肠道间质瘤临床病理观察及免疫组化分析

Gastrointestinal Stromal Tumors:A Pathomorphologic and Immunohistochemical Study of 35 Cases

目的探讨胃肠道间质瘤的临床病理及免疫组化特点。方法回顾性观察35例胃肠道间质瘤HE染色切片,复习临床病理资料,用免疫组化SP法检测CD117、CD34、Vimentin、SMA、Desmin及S-1006种抗体的表达情况。结果本组GIST均为成年人,年龄25～77岁,平均年龄51岁,其中男性19例,女性16例。发病部位:胃18例(51%),小肠8例(23%),大肠3例(9%),食管1例(3%),肠系膜3例(9%)大网膜2例(6%)。临床症状以腹部包块、腹部胀痛不适、消化道出血为主。大体上,肿瘤常有出血、坏死、囊性变等继发改变。肿瘤镜下主要由梭形和上皮细胞组成,呈交叉束状、漩涡状、栅栏状、片块状、巢状等多种排列。CD117、CD34、Vimentin、SMA、Desmin及S-100阳性率分别为:97%、83%、100%、37%、3%、26%。良性7例,交界性5例,恶性23例。结论间质瘤多发生于中老年人,胃肠道是其好发部位,细胞形态多变,排列结构多样。CD117、CD34是其特异和敏感抗体,在间质瘤的诊断和鉴别诊断中起重要作用,核分裂象>5/50HPF、肿瘤坏死、细胞密集是重要的恶性指征。

Objective To investigate the clinicopathologic and immunohistochem-ical characteristics of gastrointestinal stromal tumors（GIST）.Methods The clinical and pathological data as well as H-E stained slides of 35 cases of GISTs were reviewed.The expressions of CD117、CD34、Vimentin、SMA、Desmin and S-100 were detected by immunohistochemical SP method.Results All patients were adults,age range from 25 to 77 years,mean 51 years,male 19 cases and female 16 cases;the tumors were situated in stomach（18 cases）,in small intestine（8 cases）,in large intestine（3 cases）,in esophagus（1 cases）,in mesenterium（3 cases）and in omemtum（2 cases）.The most common symptoms were abdomen mass,vague pain and GI bleeding.Grossly,they were of soft consistency often with hemorrhage,cystification or necrosis.Microscopically,the tumors were composed of spindle cells and epithelioid cells,arrangde in interlacing fasicles,whirling,pallisading,disffusing sheets and alveolar et al.The positive rates of CD117、CD34、 Vimentin、SMA、Desmin and S-100 in 35 cases were 97%,83%,100%,37%,3% and 26% respectively.seven cases were benign,five cases borderline and 23 cases malignant.Conclusion GIST predominantly occurred in middle aged or old patients,GIST seems to occurmost frequently at gastrointestinal tract,the tumors had varied all types and different arrangements.CD117 and CD34 were the more specific and sensitive antibody in diagnosis of GISTS.Mitotic activity over 5/50HPF,high tumor cellularity and tumor necrosis were the helpful param eters forjudgement of malignancy.