107例胃肠间质瘤的病理学分析及临床诊治

目的总结胃肠间质瘤(GIST)的临床病理和免疫组织化学(免疫组化)特征,并评价预后。方法对1996年4月至2005年10月收治的107例GIST患者的临床资料进行回顾性分析。结果107例GIST病例中,73例(68.2%)为胃间质瘤,其他为小肠、结肠和系膜、网膜及后腹膜间质瘤;肿瘤直径0.7～20cm。CD117和vimentin阳性率100%,CD34阳性率83.2%。107例患者均接受手术治疗,联合脏器切除14例次。总随访率83.2%,平均随访24.5个月。14例(13.1%)发现复发或转移,其中4例为GIST中度恶性风险者。10例为高度恶性风险者;死亡4例。结论GIST的确诊主要依靠病理及免疫组化,CD117是诊断GIST的重要标记物,手术完整切除肿瘤效果满意,恶性GIST宜行较大范围的切除术。必要时须行联合脏器切除。

A clinicopathological study on 107 cases with gastrointestinal stromal tumors

Objective To investigate the clinicalpathological characteristics and prognosis of gastrointestinal stromal tumors (GISTs).Methods One hundred and seven cases,admitted to our hospital from Apr.1996 to Oct.2005,were detected by Envision immunohistochemical method and diagnosed as GISTs.Their pathological features,immunohistochemical phenotypes,clinical manifestations and imaging findings were analyzed.Results Of the 107 GISTs,107 cases were positive for vimentin (107/107,100%),107 cases were positive for CD117 (107/107,100%),89 cases were positive for CD34 (89/107,83.2%),14 cases were positive for SMA (14/107,13.1%), 10 cases were positive for desmin (10/107,9.3%),22 cases were positive for S-100 (22/87,20.6%) and 15 cases were positive for NSE (15/107,14.0%).Among all the GISTs,73 cases occurred in stomach (68.2%),28 in small intestine (26.2%),1 in colon (0.9%) and 5 occurred in other position including mesentery,omentum,and retroperitoneum (4.7%).Fifteen cases were diagnosed as very low grade (14.0%),25 cases as low grade (23.4%),33 cases as low malignancy (30.8%) and 34 cases as high malignancy (31.8%).The follow-up was obtained successfully in 89 cases (83.2%). Fourteen cases (13.1%) were confirmed to have recurrences or metastases by review and medical records. Conclusions The diagnosis of GIST depends on pathological observation and immunohistochemical study.CD117 is a sensitive marker for the diagnosis of GIST.Surgical resection is the choice for treating GIST.Extended resection,even combined resection of involved organs,is required for malignant GIST.