下消化道间叶源性肿瘤CT仿真内镜与病理的对照研究

目的 观察下消化道问叶源性肿瘤(GIMTs)的病理及免疫组化特点,对照研究其与CT仿真内镜(CTVE)诊断之间的关系,评价CTVE在下消化道GIMTs中的诊断价值.方法 收集74例下消化道GIMTs患者的手术病理标本,采用光镜观察其病理特点及良恶性状况,免疫组化法检测其CD117、CD34、α-平滑肌抗体(SMA)及S-100蛋白的表达,并与术前CTVE判定的病变部位及良恶性结果进行对照研究.结果 经病理及免疫组化检查,40例(54.1%)诊断为胃肠道间质瘤(GIST),其中恶性间质瘤16例(40%);33例(44.6%)诊断为平滑肌瘤;1例(1.4%)诊断为神经鞘瘤.发病部位位于空肠33例,回肠21例,大肠20例.免疫组化:CD117阳性38例,占51.4%;CD34阳性27例,占36.5%;SMA阳性46例,占62.2%,S-100阳性1例(1.4%).CTVE对病变部位准确定位69例(93.2%).其中大肠准确定位18例,符合率90.0%;空回肠准确定位51例,符合率94.4%.CTVE判断良恶性GIST的敏感性为84.2%,特异性为85.7%.结论 GIST是下消化道最常见的GIMTs,发病部位以小肠居多.CTVE能准确显示肿瘤的部位、形态、大小,可术前准确定位GIMTs,对其良恶性判断具有较高的敏感性和特异性,可为术前制定合理手术方案和治疗策略提供重要依据.

A comparative study of CT virtual endoscopy imaging and pathologies of lower alimentary tract mesenchymal tumors

Objective To study the pathological and immunohistochemical features of alimentary tract mesenchymal tumors and compare with computed tomographic virtue endoscopy (CTVE) imaging technology to evaluate the diagnostic value of CTVE in alimentary tract mesenchymal tumors. Methods Seventy-four pathological specimens of alimentary tract mesenchymal tumors were collected. The pathological features and the expression of CD117, CD34, SMA and S-100 were observed by immunohistochemical method with light microscope. The pathological types and characteristics were determined by pathologists and compared with CTVE imaging technology. Results In the 74 cases of alimentary tract mesenchymal tumors,40 cases were diagnosed as stromal tumor with pathological and immunohistochemical methods (54. 1%).Sixteen of them were malignant, accounting for 40% of the stromal tumor while 33 cases were diagnosed as leiomyoma(44. 6%)and 1 case as schwannoma(1.4%) . In the 74 GIMTs cases ,33 were jejunum GIMTs,21 were ileum GIMTs and 20 were large intestine GIMTs. Immunohistochemistry assay in the 74 GIMTs cases showed that 51.4% GIMTs were positive for CD117, approximately 36. 5% were positive for CD34 , 62.2% were positive for smooth-muscle actin (SMA) and 1. 4% were positive for S-100 protein. In the 74 GIMTs cases,69 cases were diagnosed right in the accuracy for location with CTVE(93. 2%) with 51 cases in small intestinal (94. 4%) and 18 cases in large intestinal (90. 0%). The sensitivity and the specificity of CTVE to distinguish benign from malignant stromal tumors by CTVE characteristics were 84. 2% and 85. 7%respectively. Conclusions GIST is common in GIMTs and is often originated from the small intestinal. The immunohistochemistry has great value in diagnosing alimentary tract mesenchymal tumors. The CTVE imaging technology also has great value in diagnosing alimentary tract mesenchymal tumors which can show the localization, shape size and artery of the tumor clearly. The diagnostic sensitivity and specificity of CTVE are high to distinguish benign from malignant alimentary tract GISTs. CTVE plays an important role in guiding the clinical management of GISTs.