合并消化道癌的胃肠间质瘤21例临床病理及免疫组织化学分析

Clinicopathologic and Immunohistochemical Analysis of 21 Cases of Coexistence of Gastrointestinal Stromal Tumors with Primary Gastrointestinal Carcinoma

目的分析胃肠间质瘤(GIST)合并消化道癌的临床病理特征及免疫组织化学(免疫组化)表型。方法回顾分析合并消化道癌的GIST 21例的临床病理特征及随访资料,部分病例补充完善CD117、DOG-1、CD34、Vimentin、Actin、S-100、EGFR、VEGF、Ki-67免疫组化检查。结果合并消化道癌的GIST以60岁以上男性多见,发生部位以胃体最常见,本组发生在胃体12例,胃底5例,肠道3例,食管1例;合并胃体腺癌12例,食管鳞癌5例,结肠腺癌2例,十二指肠腺癌、空肠腺癌各1例。除消化道癌的常见症状外,均无其他特异性症状,术前GIST均漏诊。免疫表型:CD117、DOG-1、Vimentin阳性率为100%(21/21),CD34为94.4%(19/21),EGFR、VEGF、Ki-67分别为19.0%(4/21)、28.6%(6/21)、23.8%(5/21)。2例Actin和1例S-100灶性区域阳性。GIST危险度分级:极低危7例,低危10例,中危3例,高危1例。随访1～5年,死亡11例(52.4%),均因消化道癌转移及复发死亡。结论伴发消化道癌的GIST较单发GIST恶性程度低,危险度分级以极低度、低度危险为主,预后主要与消化道癌有关。

Objective To investigate the clinicopathologic characteristics and immunohistochemical expression of coexistence of gastrointestinal stromal tumors （GIST） with other primary gastrointestinal carcinoma. Methods The clinicopathologic and follow-up data of 21 patients with GIST complicated with gastrointestinal carcinoma were retrospectively studied. The expression of CD117, DOG-1, CD34, Vimentin, Actin, S-100, EGFR, VEGF and Ki-67 were detected by immunohistochemica] method in some patients with GISTs. Results 21 patients with GIST were mostly males over the age of 60 and the outgrowth mostly occurred in the gastric body, and the numbers in gastric body, gastric fundus, intestine and esophagus were 12, 5, 3 and 1 respectively. Among them, the numbers of coexistence of GIST with gastric adenocarcinoma, esophageal squamous cell carcinoma, colonic adenocarcinoma, duodenal adenocarcinoma and jejunal adenocarcinoma were 12, 5, 2, 1 and 1. No one had specific symptoms except common symptoms of gastrointestinal cancer and none of the GIST combined with gastrointestinal carcinoma had final diagnosis or suspected diagnosis before operation. All of the positive rates of CD117, DOG-l, Vimentin were 100% （21/21）. The positive rates of CD34, EGFR, VEGF and Ki-67 were 94.4% （19/21）, 19.0% （4/21）, 28.6% （6/21） and 23.8% （5/21）. The numbers of focal positive patients of Actin and S-100 were 2 and 1. The numbers of patients at extremely low, low, moderate and high risks were 7, 10, 3 and 1. All patients were followed-up for 1-5 years, 11 patients died of relapse or metastasis of gastrointestinal carcinoma （52.4%）. Conclusion The risk factors of complicated GIST are lower than that of simple GIST, with very low and low on the scales. The prognosis is related to primary gastrointestinal carcinoma.