胃肠道间质瘤16例临床病理分析

目的:探讨胃肠道间质瘤的临床病理、免疫组织化学特征、生物学行为及预后。方法:分析16例胃肠道间质瘤的临床资料和免疫组化染色结果。结果:患者年龄22~77岁,男女之比11∶.2。病变发生在胃肠道,以胃多见,其次为空肠和十二指肠。组织学显示肿瘤细胞排列成片状、束状、栅状,细胞呈梭形或上皮样,可见核周空泡。免疫组化标记:15例(93.8%)CD117(+);12例(75%)CD34(+);6例(37.5%)Ki-67(+),强弱不等;1例(6.3%)S-100蛋白(+);2例(12.5%)SMA(+)或灶(+);1例(6.3%)desmin(+)。2例手术后4、5个月死亡;1例术后30月复发;1例失访,其他人至今尚在,无复发。结论:胃肠道间质瘤诊断需要特异性抗体CD117、CD34的检测。恶性、高危程度组肿瘤预后不佳,综合各方面指标对其生物学行为进行判断是临床治疗与估计预后的关键。

Clinicopathologic analysis of gastrointestinal stromal tumor in 16 cases

Objective：To investigate the clinicopathologic and immunohistochemical features,biological behavior and prognosis of gastrointestinal stromal tumors（GISTs）.Methods： The clinical data were reviewed in 16 cases of GIST regarding the clinical features and immunohistochemical staining.Results：The patients ranged in age from 22 to 77 years with mean age of 49.5,and the male to female ratio was 1∶1.2.The lesion was commonly seen in gastrointestinal tract,and arose most in stomach and followed by jejunum and duodenum.Histological specimens demonstrated that the tumor cells arranged in lamel,fascicle and palisade,and shaped spindly or epithelioidly with presence of perinuclear vacuoles.Immunohistochemical detection revealed CD117（＋） in 15 cases（93.8%）,CD34（＋） in 12（75%）,strong or weak Ki-67（＋） in 6（37.5%）,S-100 protein（＋） in 1（6.3%）,smooth muscle actin（SMA） or foci（＋）in 2（12.5%） and desmin（＋） in 1（6.3%）.Two deaths were found 4 to 5 months after the surgery and 1 relapse in 30 months of the procedure.No other recurrent cases were seen except for 1 failure of being followed up.Conclusion：Estimation of GISTs requires the detection of specific CD117 and CD34.Cases of malignancy or with high risks,though,appear poor in prognosis,comprehensive evaluation of the involved markers and the biological behavior may be essential to the therapy and prediction of the outcomes of this disease.