胃肠道间质瘤病理及免疫组织化学特征与诊断标准探讨

Study on Pathological and Immunohistochemical and Diagnostic Criteria of Gastrointestinal Stromal Tumors

目的 :观察胃肠道间质瘤 (GISTs)的病理形态学及免疫组织化学特征 ,探讨其病理诊断标准。方法 :81例GISTs常规病理检查 ,用 CD1 1 7、CD34 、Vimentin等抗体 ,通过免疫组织化学 S- P法对原发于胃肠道非上皮性梭形细胞肿瘤进行检测。结果 :本组 GISTs均为成年人 ,年龄 2 7～ 87岁 ,≥ 5 0岁 6 0例。男 39例 ,女 4 2例。发生于胃 39例 ,小肠 32例 ,结肠 3例 ,直肠 6例 ,腹膜后 1例。镜下观察 GISTs由梭形细胞和上皮样细胞构成 ,Vimentin、CD1 1 7、CD34 多为弥漫阳性 ,阳性率分别为 98.8%、97.5 %、75 .3% ,SMA、HHF35、S- 10 0、呈局灶或少数细胞阳性表达 ,阳性率分别为 32 .1%、2 5 .9%、8.6 %、,结蛋白均阴性。本组按 L ewin等提出的标准判断 GISTs的良恶性 ,结果良性 16例 ,恶性 4 1例 ,潜在恶性2 4例。结论 :GISTs好发于中老年人 ,该肿瘤具有多向分化特征及较特异的免疫表型 (CD1 1 7、CD34 阳性 ,desmin阴性 ) ,光镜形态易与平滑肌肿瘤 ,神经源性肿瘤混淆 ,免疫组化在 GISTs诊断中起主要作用。 GISTs良恶性判断尚需综合分析。

Objective:To study the pathological morphogical and immunohistochemical features of gastrointestinal stromal tumors (GISIs) and to explore the pathological diagnostic criteria.Methods:81 cases of GISTs were deteced with routine pathological observation and antibodies such as CD 117,CD 34, vimentin were used by immunohistochenmical S-P method in tumors of gastrointestinal non-epithelial with spindle cells.Results:All patients were adults, agerange to 87 years , 60 cases were fifty years older, male 39 cases 27 and female 42 cases,the tumors were situated in stomach (39 cases), in small intestine (32 cases), in colon ( 3 cases) , in rectum ( 6 case) and in retro peritoneum (1 cases) .Microscopically , the GISTs were composed of spindles cells and epithelioid cells, vimentin, CD 117 and CD 34 showed diffuse strong expression,the positive rates were 98.8%,97.5%,75.3%, respectively, SMA,HHF35,S-100 showed focal or a few cell expression, positive rates were 32.1%, 25.9%,8.6%,respectively, desmin were all negative. Refer to Lewin standard classification, 16 cases were benign,41 cases malignant and 24 cases borderline.Conclusion:GISTs predominantly occurred in middle aged or old patients and have a multi-differentiational capacity and specific immunohistochemical phenotype (CD 117,CD 34 were positive, desmin were negative).Under light microscope , GISTs were prone to misdiagnosed as leiomyomas and Schwannomas. Immunohistoche-mistry assays plays a major role in diagnosis,The decition of malignant or benign of GISTs is epend on integrative analysis.