胃肠间质瘤的临床及病理特征分析138例

Clinical and pathological features of gastrointestinal stromal tumors:an analysis of 138 cases

目的:探讨胃肠道间质瘤(gastrointestinal stromal tumors,GIST)的临床、病理和免疫组织化学特征.方法:收集澳门仁伯爵医院及北京医院2002-01/2008-07资料完整GIST患者138例的临床、手术及病理资料、免疫组织化学测得的CD117、CD34、SMA、Desmin、S100蛋白表达结果,回顾性分析GIST临床与病理的特点及关系.结果:138例间质瘤位于胃90例(65.22%),小肠36例(26.09%),结直肠9例(6.52%),腹膜后3例(2.17%);最大直径1-14cm.瘤组织由梭形细胞和/或上皮样细胞构成.梭形细胞:形态较一致,呈长梭形,胞质丰富,嗜酸性,胞核呈杆状或腊肠样或长梭形,大多数似平滑肌细胞,少许似神经鞘或神经纤维细胞;上皮样细胞:体积较大,形态不一,呈多角形或卵圆形,胞质空亮或微嗜酸性,核周出现亮区,核形多样与核分裂数成正比.梭形细胞型114例(82.61%),上皮样细胞型6例(4.35%),混合型18例(13.04%);核分裂小于或等于5个/50HPF99例,5-10个/50HPF24例,大于10个/50HPF15例.免疫组织化学阳性表达率为CD11797.38%,CD3473.91%,SMA6.52%,Desmin2.17%,S1002.17%;良性肿瘤24例(17.39%),低度恶性潜力39例(28.26%),中度恶性潜力33例(23.91%),高度恶性潜力21例(15.22%),恶性21例(15.22%).结论:GIST具有独特的临床特征;CD117对GIST的诊断具有较高的特异性和敏感性,但与CD34、SMA、Desmin、S100等同时检测有助于GIST的诊断;GIST良恶性的评估取决于肿瘤的部位、大小和核分裂数的多少.

AIM：To explore the clinical,pathologic and immunohistochemical characteristics of gastrointestinal stromal tumors（GISTs）.METHODS：The clinical,surgical,immunohistochemical and pathologic data for 138 patients with GISTs were retrospectively analyzed.The expression of CD117,CD34,SMA,Desmin and S-100 was detected using the Envision immunohistochemical method.RESULTS：The lesion was located in the stomach in 90 cases（65.22%）,in the small intestine in 36 cases（26.09%）,in the colorectum in 9 cases（6.52%）,and in the retroperitoneum in 3 cases（2.17%）.Of 138 cases,114 were detected as spindle type,6 as epithelioid type,18 as mixture type;99 had mitotic figures ≤5/50 HPF,24 had mitotic figures 5-10/50 HPF,15 had mitotic figures 10/50 HPF;97.38% werepositive for CD117,73.91% for CD34,6.52% for SMA,2.17% for Desmin,2.17% for S100（2.17%）;24（17.39%） were benign,39（28.26%） had low tendency of malignancy,33（23.91%） had moderate tendency of malignancy,21（15.225%） had high tendency of malignancy,21（15.22%） were malignant.CONCLUSION：GISTs have unique clinical and pathologic characteristics.CD117 detection has high specificity and sensitivity in diagnosing GISTs.Detecting CD34,SMA,Desmin,and S100 together can help diagnose GISTs.The malignancy of GISTs depends on the size,location and mitotic count of the lesion.