【摘要】 目的探讨胃肠道间质瘤(gastrointestinal stromal tumor,GIST)临床与病理组织学分化的特性。方法应用免疫组化染色对30例胃肠道间质瘤进行回顾性分析。结果30例GIST,胃和小肠分别为9例和8例,共占56.67%;食管1例;胃肠道外12例,占40.00%。年龄22~73岁,平均49.67岁,45岁以上23例,占76.67%。男14例,女16例。28例均有临床症状,腹部肿块9例(30.00%),腹痛8例(26.67%),黑便7例(23.33%);2例体检发现。肉眼观察:肿瘤直径2~9cm,平均4.6cm,其中直径<3cm18例(60.00%),≥3cm12例(40.00%)。镜下观察:梭形细胞型19例(63.33%),上皮样细胞型7例(23.33%),混合细胞型4例(13.33%)。免疫组化:30例Vimentin均阳性;22例表达CD117(73.33%),为胞浆/胞质强阳性,其中17例同时表达CD34(77.27%);7例表达S-100、SM;6例表达CK;5例表达Actin、HHF35。病理诊断良性4例,交界性6例,恶性20例。伴肌纤维分化9例,神经纤维分化4例,肌纤维和神经分化3例,肌纤维骨组织分化1例,伴黏液样变2例。结论GIST病理特征以梭形细胞为主,与平滑肌性、神经性肿瘤易混淆,免疫组化染色CD117、CD34有助于诊断,伴有其他成分分化时,S-100、Actin、SM、HHF35可灶性阳性,部分表达CK。CD117阴性或仅Vimentin表达不能排除本病,应结合免疫组化、综合临床分析以提高其确诊率。肿瘤伴有神经分化或仅表达Vimentin时,往往提示临床预后不良,手术治疗是最有效的手段。更多还原

【Abstract】 Objective To explore the clinical and pathologic tissue differentiation character of gastrointestinal stromal tumor(GIST).Methods Thirty cases of GIST were analyzed with immunochemo histologic method.Results There were 30 cases of GIST,9 cases in the stomach and 8 cases in the small intestine(56.67%),1 cases in the esophagus,12 cases out of the gastrointestinal tract(40%).The mean age was 49.67(ranged from 22-73 years),including 23 cases(76.6%)over 45 years old.There were male 14 cases,female 16 cases.28 cases had the clinical symptom,including 9 cases abdomen tumour(30%),8 cases abdominal pain(26.6%),7 cases hematemesis(23.3%);2 cases were discovered by physical examination.Tumor size diameter was 2-9 cm(4.6 cm in average),including<3 cm in 18 cases(60%),≥3 cm in 12 cases(40%).There were 19 cases(63.33%)of spindle-shaped cell type,7 cases(23.33%)of epithelial cell type,4 cases(13.34%)of mixed cell type.Immunohistochemistry:30 cases Vim(+),22 cases CD117(+)(73.33%),17 cases CD34(+)(77.27%),7 cases S-100 and SM(+),6 cases CK(+),5 cases Actin and HHF35(+).Pathology:4 cases benign,6 cases border and 20 cases malignant.There were 9 cases of muscle fiber differentiation,4 cases of nerve fiber differentiation,3 cases of mixed muscle fiber and nerve differentiation,1 case of muscle fiber bone tissue differentiation and 2 cases accompanied mucoid change.Conclusions GIST was primarily the spindle-shaped cell type,easily confused with the smooth muscular or nervous tumor,which CD117,CD34 are helpful to the diagnosis.When accompanied with else differentiation,S-100,Actin,SM,HHF35 and CK may be positive.The CD117 negative or the Vim positive cannot exclude GIST.The tumor accompanied with the nerve differentiation or only Vim positive often shows bad prognosis.The surgery treatment is the most effective method.更多还原