胃肠道恶性间质瘤的临床病理分析

A Clinicopathological Study of Gastrointestinal Maligiant Stromal Tumors

目的 探讨胃肠道恶性间质瘤 (GIST)的临床病理特征 .方法 分析了 6例GIST的临床及病理特征 .结果 6例恶性GIST均无消化道梗阻 .临床表现无特异性 ,广泛分布于胃 (6 0 % ) ,小肠 (30 % )和其它部位 (10 % ) ,10 %～ 30 %GIST是恶性的 ,表现为腹腔内的扩散或肝转移 ;常规病理学检查 ,GIST与平滑肌瘤 /肉瘤等其它类型的梭形细胞肿瘤不易区别 ,确诊需要免疫组化或 /和电镜检查 ;免疫组化CD34(+ ) ,Vimenti(+ ) ,Desmin(- ) ,Actin (- ) ,S- 10 0 (- ) ;恶性GIST应行根治性手术 ,影响预后的因素较多 .结论 GIST具有独特免疫组化表型 ,是有别于平滑肌肿瘤的一类成分复杂的间叶性肿瘤 .

Objective To investigate the clinical pathologica characteristics of GIMST.Methods Six cases with gastrointestinal maligiant stromal tumor and correlative literature were retrospected and studied,We summarized the clinical pathological characteristics of the deseases.Results There were 6 cases with abdominal pain,4 cases with abdominal mass,3 cases with marasmus and weight loss,3 cases with degestive tract bleeding and anemia,and no degestive tract obstruction in this 6 cases GIMST.There was not specificity in clinical situation.It distributed widely in the stomach(60%),small intestinal(30%) and other position(10%).10%～30%of the GIST were maligiant (GIMST),its evidence was intraabdominal diffusion and hepatic metastasis. It was not easy to distinguish fusiform tumor cells between GIST and leiomyoma/leiomyosarcoma in routine pathologic examination.The final diagnosis of GIMST demanded to proceed immunohistchemistry and/or electron microscope.It showed CD34(+),Vimenti(+),Desmin(-),Actin(-),S-100(-)in immunohistochemistry.GIMST needed to make a radical operation.Many factors affected prognosis. Conclusions GIST/GIMST posses unique phenotyp in immunohistochemistry,it is a kinds of tumor of mesenchymal tissue with mixed component distinguishing leiomyomal/leiomyosarcoma.It needs to be studied further steps in therapeutic measures and prognostic agent .