胃间质瘤合并原发性消化道癌的临床病理特点

Clinicopathological characteristics of gastric stromal tumors complicated with primary gastrointestinal cancer

目的:观察胃间质瘤合并原发性消化道癌的临床病理特点。方法:选取328例胃肠道间质瘤(Gastrointestinal stromal tumors,GIST)患者为研究对象,回顾性分析其病理诊断结果,分析GIST患者合并消化道癌的部位、间质瘤的大小、核分裂象、免疫表型。结果:并发消化道癌者48例,占14.63%。所有48例均因消化道癌手术发现并确诊并发GIST,13例位于黏膜下、17例位于肌层、18例位于浆膜下。48例均具有典型的GIST病理组织学特点,均显示CD117阳性,32例同时显示CD34阳性,28例同时显示SMA灶性阳性表达,S-100蛋白均阴性。48例并发消化道癌病例中,8例有轻度异型性,其余无异型性。核有丝分裂象0~4/50 HPF,平均(0.74±1.07)/50 HPF,Ki-67阳性指数0~7.72%,平均(2.51±2.20)%,均属于I A期。GIST中合并食管癌比例较高,瘤体平均直径较小,细胞异型性小,核分裂象数和Ki-67阳性指数均较低(P<0.05)。结论:胃间质瘤合并原发性消化道癌的病理特点为消化道癌好发于食管,瘤体和细胞异型性小,核分裂像数和Ki-67阳性指数低。

Objective:To investigate clinical and pathological characteristics of gastric stromal tumors complicated with primary gastrointestinal cancer.Methods:328 patients with gastrointestinal stromal tumors(GIST)were selected as the research objects.Their pathologic results were retrospectively analyzed.Further,the combined digestive tract cancer site,the size of the stromal tumor,the mitotic count,and the immune phenotype were analyzed.Results:Among the 328 cases,48 cases were complicated with primary gastrointestinal cancer,accounting for 14.63%.All the 48 patients were diagnosed with GIST due to the gastrointestinal cancer surgery,13 cases in the submucosal,17 in the muscular layer and 18 under the serosa.The 48 cases showed typical GIST histological characteristics,all showed CD117 positive,32 cases showed CD34 positive,28 cases also showed SMA focal positive expression,and S-100 protein was negative.Moreover,among the 48 cases,8 cases had mild dysplasia,but the rest did not show dysplasia.The mitotic count was 0-4/50 HPF with an average of(0.74±1.07)/50 HPF,and the Ki-67 positive index was 0-7.72%with the average of(2.51±2.20)%.All these cases were at the IA stage.The proportion of the cases with GIST complicated with esophageal cancer was higher with a smaller tumor diameter,small cell dysplasia,and lower mitotic count and Ki-67 positive index(P<0.05).Conclusions:The pathological characteristics of the patients with GIST complicated with primary gastrointestinal cancer are frequent occurrence of gastrointestinal cancer in the esophagus,small tumor size and cell dysplasia,and lower mitotic count and Ki-67 positive index.