97例胃肠道间质瘤的临床病理分析

Clinicopathological analysis of 97 cases of gastrointestinal stromal tumors

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:收集新疆维吾尔自治区人民医院2010年8月～2013年3月资料完整GIST患者97例的临床、手术及病理资料、免疫组织化学CD117、DOG-1、CD34、SMA、Desmin、S100蛋白及Ki67表达结果,回顾性分析GIST临床与病理的特点及关系。结果:97例间质瘤位于胃71例(73.19%),小肠17例(17.53%),结直肠2例(2.06%),食道1例(1.03%),其它部位6例(6.19%)。肿瘤最大径0.3～17cm。肿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,胞核呈杆状或长梭形。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。肿瘤细胞核分裂像≤5个/50 HPF83例,6～10个/50HPF7例,>10个/50 HPF者7例。免疫组织化学阳性表达率分别为CD117、DOG-1和CD34阳性率分别为96.91%、94.85%和88.66%。SMA、Desmin和S100阳性率分别为38.14%、15.46%和16.49%。Ki67阳性率1～40%。肿瘤危险度分级,极低危险35例,低度危险30例,中度危险15例,高度危险17例。结论:GIST具有独特的临床和病理学特征,CD117和DOG-1对GIST的诊断具有较高的特异性和敏感性,联合CD34、SMA、Desmin、S100同时检测有助于诊断和鉴别诊断;GIST的危险度评估取决于肿瘤的部位、大小和核分裂数的多少。

Objective： To explore the clinical, pathologic and immunohistochemical characteristics of gastrointestinal stromal tumors（GISTs）. Methods： The clinical, operative, immunohistochemical and pathological data for 97 patients with GISTs were retrospectively analyzed. The expression of CD117, DOG - 1, CD34, SMA, Desmin, S - 100 and Ki67 was detec- ted using the Envision immunohistochemical method. Results： The lesion was located in the stomach in 71 cases （ 73 19% ） ,ill the small intestinein 17 cases（ 17.53% ） ,in the colorectum in 2 cases（2.06% ） ,and in the esophagus in 1 case （ 1.03% ） ,in the other sites in 6 cases（＆ 19% ）. Of 97 cases,83 had mitotic figures~〈5/5OHPF,7 had mitotic figures 6 - 10/50HPF,7 had mitotic figures 〉 10/50HPF;96.91% were positive for CD117,94.85% were positive for DOG- 1,88. 66% for CD34,38.14% for SMA, 15.46% for Desmin, 16.49% for S100 and 1 ~ 40% for Ki67.35 had extremely low risk,30 had low risk, 15 had moderate risk, 17 had high risk. Conclusion： GISTs have unique clinical and pathologic char- acteristics. CD117 and DOG- 1 detection has high specificity and sensitivity in diagnosing GISTs. Detecting CD34, SMA, Desmin,and S100 together can help diagnose GISTs. The risk of GISTs depends on the size,location and mitotic count of the lesion.