胃肠道间质瘤的免疫组化诊断及P^(53)和P^(21)表达

Immunohistochemical diagnosis of gastrointestinal stromal tumors and the expression of P^(53) and P^(21)

目的 探讨胃肠道间质瘤 (GIST)的诊断及鉴别诊断 .方法 GIST患者 5 0例 ,进行常规检查及 P53/P2 1 ,HHF-35 ,vimentin,CD34 免疫组化检测 .结果 本组 5 0例 GIST,恶性 34例 ,交界性 10例 ,良性 6例 ,以胃及小肠为多发(6 8% ) .免疫组化以平滑肌细胞分化为主型占 46 % ,神经源分化型占 18% ,平滑肌和神经双向分化型 18% ,未分化型2 4% .肌肉共同蛋白 HHF- 35为平滑肌细胞分化最敏感的标志物 .未分化型间质瘤的免疫表型为 vim entin和 CD34 阳性 .P53蛋白和 P2 1 蛋白对 GIST的良恶性可资鉴别 .结论 尽管胃肠道间质瘤光镜下形态相似 ,但其免疫表型呈异源性 。

AIM To study the pathological diagnosis and differ ential diagnosis of gastrointestinal stromal tumor (GIST). METHODS Rou tine and immunohistochemical (P 53/P 21, HHF-35, vimentin, CD 34 ) examinations were performed on 50 patients with GIST. RESULTS Among the 50 cases, 34 were malignant, 10 broadline, and 6 benign, and GISTs were mostly in stomach and intestine (68%). The results of immunohistochemical examination showed that the type of smooth-muscle cell differentiation accounted for 46%; neurogenic differentiation, 18%; and the differentiation type of both smooth-muscle and neurogenic, 18%; the undifferentiated type, 24%. The muscle common actin HHF-35 was the most sensitive marker of smooth-muscle cell differentiation. The immunophenotype of undifferentiated stromal tumors was the positive vimentin and CD 34. P 53 and P 21 proteins could differentiate the benign and malignant GISTs. CONCLUSION Although the microscopic figures of GIST are similar, the immunophenotypes are heterogenous. Thus immunohistochemistry must be performed for accurate qualitative analysis.