胃巨细胞血管纤维瘤临床病理观察

Clinical and pathological characteristics of gastric giant cell angiofibroma

目的探讨胃巨细胞血管纤维瘤(GCA)的临床病理特征及其鉴别诊断。方法对1例胃GCA进行胃镜、组织学观察及免疫组化染色,结合文献讨论其临床病理特点及鉴别诊断。结果患者女性,49岁,上腹部不适半年。胃镜示胃体下部后壁见一约3 cm×3 cm带蒂息肉,表面糜烂。手术切除肿块。镜下示肿瘤位于胃黏膜下层,瘤细胞呈小叶状排列,疏密相间,瘤细胞卵圆形或短梭形,并见大量多核巨细胞,巨细胞核大、深染,核型不规则,未见明显分裂象。肿瘤内血管丰富,并含有少量内衬不连续的巨细胞的假血管样腔隙。免疫组化示vimentin、CD34、CD99均(+),bcl-2部分(+)。结论本例是首次发生于胃的GCA病例报道。GCA是一种好发于成年人眼眶区,亦可发生眶区以外的良性或低度恶性潜能肿瘤,诊断与鉴别诊断主要依靠病理组织学及免疫组化,局部完整切除后较少复发,需密切随访。

Objective To investigate the clinicopathological features and differential diagnosis of gastric giant cell angiofibroma （GCA）. Methods The clinical pathologic characteristics and differential diagnosis were analyzed in 1 case of gastric GCA by using gastroscopy, histology and immunohistochemical staining with review of literature. Results This was a 49 years old female patient, with upper abdominal discomfort for half a year. Gastroscopy showed a 3 cm × 3 cm semi pedunculated polyp with surface erosion around lower posterior wall of gastric body. The tumor was surgically removed. Microscopically, the tumors located in the gastric submucosa. The tumor cells arranged in lobules with interacted density. Tumor cells were oval or spindle shaped, and there were lots of muhinucleated giant cells, which had a large nucleus with hyperchromatic and irregular karyotype, but no obvious mitotic figures were noted. Within the tumor, blood vessels were rich, discontinuous false vessel-like spaces containing giant ceils were also noted. Immunohistochemical staining showed that vimentin, CD34, CD99 were （ ＋ ）, part bcl-2 （ ＋ ）. Conclusion It is the first case report of GCA occuring in the stomach. GCA is a benign or low malignant potential tumor, likely occurring in the orbital region of adult patients, and also present outside the orbital region. The tumorg diagnosis and differential diagnosis mainly depend on the histopathology and immunohistochemistry. Complete local excision makes recurrence rate low, but close follow-up is needed.