胃肠道间质瘤的临床病理研究

A clinicopathologic study on 55 cases of gastrointestinal stromal tumor (GIST)

目的 探讨胃肠道间质瘤 (gastrointestinalstromaltumor,GIST)的临床病理特点。方法 对 5 5例GIST的病例进行分析 ,并对其进行CD117、CD34、S 10 0、SMA、vimentin、desmin、NF共 7种免疫组化分析。结果 肿瘤的发生部位 :胃 38例 (6 9% ) ,小肠 10例 (18% ) ,其他部位 7例(13% )。肿瘤直径 0 4～ 4 0cm(平均 6 7cm)。肿瘤最大直径≥ 5cm、核分裂像数≥ 5 / 5 0HPF及有溃疡形成 3项在良性与恶性之间差异有显著意义。免疫组化的阳性表达结果为 :CD11739例(71% )、CD344 5例 (82 % )、S 10 0 19例 (35 % )、SMA 12例 (2 2 % )、vimentin 32例 (5 8% )、desmin 6例(11% )、NF 2 / 4 (5 0 % )。 13例良性GIST患者全部存活 ,4 2例恶性及潜在恶性GIST中有 4例发生转移 ,13例死亡。结论 (1)GIST好发于中老年人 ,无明显性别差异。 (2 )其主要恶性指标为 :肿瘤最大径≥ 5cm、核分裂像≥ 5 / 5 0HPF和有溃疡形成。 (3)光镜下很难将平滑肌性肿瘤及神经源性肿瘤与GIST相鉴别。

Objective To investigate the clinicopathologic features of GIST. Method Fifty-five GIST cases were collected. Immunohistochemical assays of vimentin, CD117, CD34, S-100, SMA, desmin, NF were used to study the specimen. Results 69% (38/55) of the tumors located in the stomach, 18% (10/55) in the small intestine. Tumors varied greatly in size, ranging from 0.4 to 40 cm (average 6.7 cm). Morphologic criteria of malignancy are tumor size≥5 cm, mitotic rates≥5/50 HPF and ulcer formation and there were significant differences between the benign and the malignant. Immunohistochemical staining results: CD117 positive in 39 cases(71%), CD34 in 45 cases (82%), S-100 in 19 cases (35%), SMA in 12 cases (22%), vimentin in 32 cases (58%), desmin in 6 cases(11%),and NF in 2/4 (50%). All 13 benign cases were alive on the latest follow-up. In 42 cases of malignancy and potential malignancy, 4 developed metastasis, 13 died. Conclusion (1) GIST occur predominantly in middle-aged and older persons.(2) The main criteria of malignancy of GIST are tumor size≥5 cm, mitotic rates≥5/50 HPF and ulcer formation. (3)Whereas it is difficult to identify true leiomyomas/leiomyosarcomars and neuogenic tumors from GIST, immunohistochemical staining is capable of doing this.