胃平滑肌瘤与胃肠间质瘤的临床病理组织及影像特征观察

Observation of clinicopathologic tissue and imaging features of gastric leiomyoma and gastric stromal tumors

目的研究胃平滑肌瘤与胃肠间质瘤的临床病理组织以及影像特征之间的差异。方法选取2014年1月~2019年5月江西省赣州市立医院及赣南医学院第一附属医院收治的40例胃平滑肌瘤患者作为胃平滑肌瘤组,另选取江西省赣州市立医院及赣南医学院第一附属医院同期治疗的40例胃肠间质瘤患者作为胃间质瘤组,分别对两组患者的影像学以及病理学资料进行比较。结果胃平滑肌瘤组患者的结蛋白(Desmin)(+)、平滑肌肌动蛋白(SMA)(+)占比高于胃间质瘤组患者,原癌基因CD117(+)、CD34(+)、Dog-1(+)占比低于胃间质瘤组患者,差异有统计学意义(P<0.05)。对胃间质瘤组患者的病理细胞进行分析,分析结果显示,其上皮样细胞占比为(13.94±2.03)%,梭形细胞占比为(58.96±2.19)%,混合型细胞占比为(24.36±2.15)%;胃平滑肌瘤的镜检结果显示,肿瘤位于胃黏膜下层,边界清楚,肿瘤细胞呈束状交错排列。胃平滑肌瘤的CT值多为40~60 Hu,增强后呈均匀强化;胃间质瘤CT平扫密度不均匀,增强扫描包块强化明显,较大时出现坏死则强化不均匀。两组患者的回声特点比较,差异无统计学意义(P>0.05)。胃平滑肌瘤组患者的回声均匀度高于胃间质瘤组患者,回声不均匀度低于胃间质瘤组患者,差异有统计学意义(P<0.05)。结论胃平滑肌瘤与胃间质瘤患者的组织密度均匀性、Desmin、SMA、CD117、Dog-1以及CD34等结果存在差异,可将患者的组织密度均匀性、Desmin、SMA、CD117、Dog-1以及CD34免疫组化等结果作为鉴别诊断的重要依据。

Objective To study the difference of clinicopathological and imaging features between gastric leiomyoma and gastric stromal tumors. Methods A total of 40 patients with gastric leiomyoma were treated in Ganzhou Municipal Hospital and the First Affiliated Hospital of Gannan Medical University from January 2014 to May 2019 were selected as gastric leiomyoma group. Another 40 patients with gastrointestinal stromal tumors treated in Ganzhou Municipal Hospital and the First Affiliated Hospital of Gannan Medical University at the same time were selected as gastric stromal tumor group. The imaging and pathological datas of the patients between the two groups were compared. Results The proportions of defibrin(Desmin)(+), anti-smooth muscle antibody(SMA)(+) and cell proliferation marker Ki67(+)in the gastric leiomyoma group were higher than those in the gastric stromal tumor group, and the proportions of protooncogenes CD117(+), proto-oncogenes CD34(+) and Dog-1(+) in the gastric leiomyoma group were lower than those in the gastric stromal tumor group, with statistically significant differences(P<0.05). The pathological cells of the gastric stromal tumor group were analyzed, and the results showed that the proportion of epithelioid cells was(13.94 ±2.03)%, the proportion of spindle cells was(58.96±2.19)%, and the proportion of mixed cells was(24.36±2.15)%. Microscopic examination of the gastric leiomyoma showed that the tumors were located in the submucosa of the stomach,with clear boundaries and tumor cells arranged in bundles. The CT value of gastric leiomyoma was mostly 40-60 Hu,which showed uniform enhancement after enhancement. The density of CT plain scan of gastric stromal tumor was not uniform, and the enhancement of mass in enhanced scan was obvious, when the necrosis was large, the strengthening was not uniform. There was no significant difference in the echo characteristics between the two groups(P >0.05). The echo uniformity of the gastric leiomyoma group was higher than that of the gastric stromal tumor group, and the echo not uniformity was lower than that of the gastric stromal tumor group, and the differences were statistically significant(P<0.05). Conclusion There were differences in tissue density uniformity, Desmin, SMA, CD117, Dog-1 and CD34 in patients with gastric leiomyoma and gastric stromal tumor, the results of tissue density uniformity, Desmin,SMA, CD117, Dog-1 and CD34 immunohistochemistry can be used as the important basis for differential diagnosis.