临床影像学联合组织病理大切片在胃肠间质瘤术后化疗的意义和价值

Significance and value of combined application of pathological large section technique and clinical imaging in postoperative chemotherapy of gastrointestinal stromal tumors

目的进行组织病理学大切片,参照术前CT和MIR影像学资料,比较鉴别诊断胃肠间质瘤,为术后化疗和预后提供理论依据。方法收集10例常规HE染色和免疫组化CD117、CD34、SMA和S-100染色确诊为胃肠间质瘤患者的离体手术大体标本制作组织病理学大切片,常规HE染色,对比CT和MIR影像结果,观察分析胃肠道间质瘤的情况。所有离体组织的断端距离肿物至少2cm,沿肿物最大直径切开,留取1cm厚组织,保持肿物的完整。结果胃肠间质瘤组织病理学大切片制片效果良好,可以清楚观察肿瘤的全貌和大小、每10HPF核分裂象个数、肿瘤的浸润程度、肿瘤的坏死以及肿瘤的包裹情况,参考术前的CT和MIR影像学资料,进一步全面了解胃肠道间质瘤,为临床治疗服务。结论胃肠间质瘤组织病理学大切片比常规病理切片更全面、更具体地反映肿瘤的情况,能明确肿瘤大小,最大程度反映肿瘤的的全貌、浸润程度、坏死情况和每10HPF核分裂象个数,对胃肠间质瘤患者的预后评估及后续化疗制定有效的方案,为患者服务。

Objective To provide a theoretical basis for postoperative treatment and prognosis of gastrointestinal stromal tumors(GISTs)by differential diagnosis of GISTs which combined large section technique for surgical resection specimens with imaging data of preoperative CT and MRI.Methods 10 Patients of GISTs were diagnosis using HE staining and immunochemical staining for CD34 and CD117.Radical resection of the modified or standard operation was performed in these patients.The surgical resection biopsies had bowel ends distance of at least 2cm to tumor margin.The tumor was not open at the maximum diameter,and 1cm thick tissue was taken for pathological large sections with the remaining structural integrity.Results The excellent effect of the pathological large section technique clearly showed all parts of the tumor,mitotic count per 10 HPF and the degree of tumor invasion and necrosis.CT and MRI imaging data help to acguire more information about the character of gastrointestinal stromal tumors.Conclusion Tumor pathological large sections,can contribute to a comprehensive and clear understanding of tumors,including identification of tumor size,degree of tumor invasion and necrosis,and mitotic count per 10 HPF.The large section technique proposed is very helpful to the prognosis and follow-up treatment of gastrointestinal stromal tumors.