胃肠间质瘤的病理学诊断及病理特点分析

Pathological diagnosis and analysis of pathological characteristics of gastrointestinal stromal tumors

目的观察胃肠间质瘤的病理学诊断并分析其相关病理特点。方法回顾性分析2016年1月至2019年12月本院收治的89例胃肠间质瘤患者的临床资料,通过常规苏木精-伊红染色法(HE染色法)及免疫组织化学(S-P法)染色观察胃肠间质瘤的病理学特征、免疫组织化学特点,分析其生物学行为。结果89例患者中,极低度风险者24例,低度风险者12例,中度风险者39例,高度风险者14例。胃肠间质瘤主要由梭形细胞及上皮样细胞共同组成,其中梭形细胞47例,上皮样细胞16例,混合型26例;按肿瘤细胞免疫表型分类:平滑肌分化23例,神经分化16例,双向分化28例,未分化22例。89例患者中,CD117、CD34、S-100、Desmin、SMA阳性表达率分别为93.26%、69.66%、42.70%、46.07%、43.82%。结论胃肠间质瘤早期诊断率较低,具有独特的肿瘤细胞免疫表型及组织形态学,CD117、CD34阳性表达是诊断疾病的重要依据,临床可依靠肿瘤大小、核分裂相及肿瘤密集程度等进一步判断肿瘤恶性程度。

Objective To observe the pathological diagnosis of gastrointestinal stromal tumors and analyze its pathological characteristics.Methods The clinical data of 89 patients with gastrointestinal stromal tumors admitted to our hospital from January 2016 to December 2019 were retrospective analyzed,through conventional hematoxylin-eosin staining method(HE staining method)and immunohistochemistry(S-P method)staining to observe the pathological and immunohistochemical characteristics of gastrointestinal stromal tumors,and analyze their biological behaviors.Results Among the 89 patients,24 cases were at extremely low risk;12 cases were at low risk;39 cases were at moderate risk;14 cases were at high risk.Gastrointestinal stromal tumors were mainly composed of spindle cells and epithelioid cells,of which 47 cases were spindle cells,16 cases were epithelioid cells,and 26 cases were mixed types;classified by tumor cell immunophenotype,23 cases of smooth muscle differentiation,16 cases neural differentiation,28 cases were bidirectional,22 cases were undifferentiated.Among the 89 patients,the positive expression rates of CD117,CD34,S-100,Desmin and SMA accounted for 93.26%,69.66%,42.70%,46.07%and 43.82%,respectively.Conclusion The early diagnosis rate of gastrointestinal stromal tumors is low,with unique tumor cell immune phenotype and histomorphology.The positive expression of CD117 and CD34 is an important basis for diagnosis of disease.Clinical size can be further depended on tumor size,mitotic phase and tumor density to judge the degree of malignancy of the tumor.