胃肠间质肿瘤临床病理与免疫组化特征

Clinicopathologic and Immunohistochemical Study of Gastrointestinal Stromal Tumors

目的:探讨胃肠间质瘤(GISTs)临床病理、免疫组化及组织分型。方法:44例胃肠非上皮梭形细胞肿瘤常规检查,Vimentin、Desmin、SMA、S-100、CD345种抗体采用Envision法免疫组化检测。44例非上皮梭形细胞肿瘤中,GISTs37例,占84.1%,良性GISTs8例,潜在恶性GISTs7例,恶性GISTs22例。临床以消化道出血,疼痛多见。光镜下为梭形细胞和上皮样细胞两种基本成分。结果:37例GISTs中,Vimentin、Desmin、SMA、S-100、CD34阳性分别为94.6%、5.4%、43.2%、48.7%、89.2%,其中GISTsⅠ型8例(21.6%),GISTsⅡ型10例(27.1%),GISTSsⅢ型8例(21.6%),GISTsⅣ型11例(29.7%)。结论:GISTs是胃肠道最常见的间质性肿瘤,具有多向分化特性,HE形态类似,免疫组化在GISTs诊断中起主要作用,CD34有较高的特异性和敏感性。

Objective:To investigate the clinicopathologic and immunohistochemical characteristics and the histologic classification of gastrointesitinal stromal tumors(GISTs).Methods :Forty -four cases of gastrointestinal non -epithelial neoplasms with spindle cells were examined rou tinely and the expression of five kinds of antibodies including Vim,Des,SMA,S-100and CD 34 were detected by immunohistochemical technique(Enivion's method)in them.Results:The GISTs accounted for84.1%(37/44)in which8cases were benign,7cases latently malignant and22cases malignant.Gastrointestinal hemorrhage and pain occurred frequently as the main clinical manifestations.Spindle and epithelioid cells were the two principal compositions observed under light microscope.In37cases of GISTs,the positive rates of Vim,Des,SMA,S-100and CD 34 were94.6%,5.4%,43.2%,48.7%and89.2%respectively,and8cases(21.6%)were GISTs Ⅰtype,10(27.0%)GISTs Ⅱtype,8(21.6%)GISTs Ⅲtype,11(29.7%)GISTs Ⅳtype.Conclusion:GISTs are the most common stromal tumors of gastrointestinal tract with multiple differentiated characteristic and morphological similarity in HE stain.Immunohistochemistry plays a main role in the diagnosis of GISTs,whereas CD 34 has relatively high specificity and sensitivity.