多结节状胃梭形细胞肿瘤3例临床病理观察并文献复习

Multinodular gastric spindle cell tumors:clinical and pathological analyses of three cases with review of literature

目的探讨3例胃多结节状梭形细胞间叶源性肿瘤(例1胃丛状纤维黏液瘤、例2胃神经鞘瘤伴有固有平滑肌累犯、例3胃多发平滑肌瘤)的临床病理表现、诊断、鉴别诊断及其病变发生、发展的可能原因。方法收集3例肿瘤患者临床资料,组织常规HE染色,免疫组织化学En Vision法分别标记PDGFR、Dog-1、CD117、Desmin、Actin、S-100、SOX10、ALK,并结合文献讨论及相关分析。结果例1呈多结节状,结节内富含小血管,梭形细胞散在分布于黏液基质内,个别结节呈蘑菇样、蟹足样向胃壁平滑肌穿插,可见淋巴细胞围绕。例2肿瘤由胞质淡嗜伊红色的梭形细胞构成,局部呈条束状排列。结节外围部分肿瘤细胞向胃壁侵袭生长形成多个小结,周围可见淋巴细胞套。例3肌壁间见2个结节,结节由梭形细胞呈编织状排列,梭形细胞胞质丰富、强嗜伊红色。免疫组化:PDGFR、Dog-1、CD117均(-),其余均符合各自特征性表达。结论3例肿瘤均由梭形细胞构成,鉴别诊断方面均必须首先排除胃肠间质瘤。3者都属于良性肿瘤且预后良好,都能形成多结节状或多发,例1、2的多结节或多发可能与肿瘤结节的侵袭性有关。

Objective To investigate the clinicopathological manifestations,diagnosis,differential diagnosis and possible causes of 3 cases of multinodular gastric spindle cell mesenchymal tumors.Methods Three patients with gastric spindle cell tumor involved in this study:the first patient was present with gastric plexiform fibromyxoma,the second patient with gastric schwannomas with inherent smooth muscle recidivism,and the third patient with gastric multiple leiomyoma.Clinical data of these 3 patients were collected,and conventional HE staining was performed.PDGFR,Dog-1,CD117,desmin,actin,S-100,SOX10 and ALK were labeled with immunohistochemical methods,and then a review of the literature and discussion were made.Results Patient 1 showed multiple nodules,which riched in small blood vessels.The spindle cells were scattered in the mucuous matrix.Some of the nodules were mushroom-like or crab-foot-like which interspersed into the smooth muscle of the gastric wall,with lymphocytes surrounded.In patient 2,the tumor was composed of spindleshaped cells with pale eosinophilic cytoplasm,partly arranged in stripes.Tumor cells in the periphery of the nodule invaded and grew into the gastric wall,forming multiple nodules and lymphocyte sheaths were seen.In patient 3,two nodules were seen between the muscle walls.The nodules were arranged in a braided manner by spindle cells.The spindle cells were rich in cytoplasm and strongly eosinophilic.Immunohistochemical staining showed PDGFR,Dog-1,and CD117 were negatively expressed in these 3 cases,and the rest were consistent with their respective characteristic expressions.Conclusions All of the three tumors are composed of spindle cells,and gastrointestinal stromal tumors must be ruled out in the differential diagnosis.All these cases belong to benign tumors and have a good prognosis.They can form multiple nodules or involve multiple regions.The multiple nodules or multiple regions of cases 1 and 2 may be related to the aggressiveness of tumor nodules.