154例胃肠道间质瘤的临床病理及免疫组化特征

Gastrointestinal stromal tumors: a clinicopathologic and immunohistochemical study of 154 cases

目的 探讨胃肠道间质瘤 (GIST)的临床病理、免疫组化特点及危险度参考指标。方法 应用光镜观察 1 5 4例GIST的形态特征 ,用免疫组化L -SAB法检测CD1 1 7,CD34,vimentin ,HHF35 ,S1 0 0蛋白及bcl2在GIST中的表达情况。结果 1 5 4例GIST占同期消化系统间叶肿瘤的 88 0 % ,年龄 2 0～ 92岁 (平均 5 5岁 ) ,男女之比为1 5 7∶1。镜下梭形细胞为主型 1 38例 (89 6 % ) ,上皮样细胞为主型 7例 (4 6 % ) ,混合细胞型 9例 (5 8% )。免疫组织化学显示CD1 1 7及CD34的阳性率分别为 6 8 8%和 92 9% ,HHF35部分有灶性的表达 ,S1 0 0蛋白一般不表达 ,bcl2阳性率较高 (70 1 % )。结论 GIST是消化道最常见的间叶性肿瘤 ,CD1 1 7,CD34,vimentin ,HHF35 ,S - 1 0 0蛋白联合使用可协助鉴别诊断GIST。肿瘤直径大于 5cm、核分裂数大于 5 / 5

Objective To investigate the clinicopathologic and immunohistochemical features of gastrointestinal stromal tumors (GIST) and the reference parameters for malignancy. Methods The clinicopathologic characteristics of GISTs were studied in 154 cases using light microscopy. The expression of CD117, CD34, vimentin, HHF35, S-100 and bcl 2 were detected in all cases with L-SAB staining. Results 154 cases of GIST were equivalent to 88% (154 to 175) of all mesenchymal tumors of gastrointestinal tract in the same period. The age range was 20～92 years (mean 55 years). Male to female was 1 57 to 1. Microscopically, 138 were of spindle cell type, 7 were of epitheloid cell type and 9 were of mixture type among 154 cases of GIST. Immunohistochemically, the positive rates of CD117 and CD34 were 68 8% and 92 9% respectively. HHF35 showed focal expression in some cases. S100 protein was generally not expressed and positive rate of bcl 2 was high (70 1%). Conclusion GIST were the most frequent mesenchymal tumor of the gastrointestinal tract. Application of immunohistochemical markers (CD117,CD34,Vimentin,HHF35 and S-100) is necessary for differential diagnosis. Diameter greater than 5 cm and mitotic activity over 5/50HPF is a highly potential malignant parameters.