光镜诊断383例平滑肌肿瘤组织发生学的重新评价

目的 重新评价胃肠道平滑肌肿瘤的组织发生。方法 对38例光镜诊断胃肠道平滑肌肿瘤用组织化学和免疫组化方法。组合分类判别各例组织的来源，结果发现光镜诊断胃肠道平滑肌肿瘤并非单一平滑肌源性(39．4％)，还有神经源性(13．2%)，混合性(42．1％)及未分化性(53％)。结论 作认为应将胃肠道平滑肌肿瘤归为胃肠道问质瘤的范畴，再用免疫组化标记及电镜阐明组织发生，为临床治疗和判断预后提供更准确的依据。     

265例胃肠道间叶源性肿瘤的临床病理特征及超声内镜诊断价值

目的探讨胃肠道间叶源性肿瘤（gastrointestinal mesenchymal tumor,GIMT）的临床病理特征及超声内镜（edoscopic ultrasonography,EUS）的诊断价值.方法观察265例GIMT病理特征并检测CD117、CD34、平滑肌肌动蛋白（SMA）、S-100、Ki-67等抗体的表达情况,确诊后回顾其中32例术前EUS检查结果.结果 265例GIMT中胃肠道间质瘤（gastrointestinal stromal tumor,GIST）146例,平滑肌（肉）瘤（leiomyoma or leiomyosarcoma）113例,神经源性肿瘤6例.免疫组化结果：GIST以CD117阳性132/146（90.4%）和CD34阳性109/146（74.7%）为主,SMA和S-100分别在平滑肌（肉）瘤和神经鞘膜瘤中强阳性表达,9例GIST中7例Ki-67阳性且伴较多有丝分裂,病理诊断为交界性或恶性GIST.交界性、恶性GIST多见于男性患者.EUS对GIST、平滑肌瘤的定位准确率为96.9%,诊断准确率84.4%,良恶性鉴别准确率71.9%.结论 GIMT主要为GIST.形态上类似的GIST与平滑肌瘤及神经鞘膜瘤区别可用CD117、CD34、SMA、S-100等多种免疫组化标记物.联用Ki-67表达和有丝分裂数判断间质瘤的良恶性的敏感性、特异性高.EUS对于GIMT的诊断及良恶性鉴别有一定的应用价值,结合EUS引导下细针穿刺（EUS-FNA）活检是未来的诊断选择.     

53例胃肠道间叶性肿瘤内镜特点及病理研究

目的 观察53例胃肠道间叶性肿瘤的内镜和病理特点,加强对间叶性肿瘤的鉴别诊断.方法 收集53例胃肠道间叶性肿瘤患者的影像、病理资料,并完成CD117、CD34、SMA和Desmin的免疫组化检查,分析胃肠道间叶性肿瘤的临床、内镜、病理和免疫组化特征.结果 间质瘤和平滑肌源性肿瘤在内镜超声中有一定的影像学特点;胃和食管发生间质瘤和平滑肌瘤比例高于消化道其他部位,分别为64.71%和68.42%;间质瘤中CD117和CD34为弥漫性阳性表达,SMA和Desmin阳性表达率较低,但在小肠病例中SMA表达较CD34高;平滑肌源性肿瘤中SMA和Desmin呈弥漫阳性表达,而CD117和CD34的表达显著低于间质瘤;同时根据相关性分析证实,Desmin阴性对间质瘤的诊断意义增强,CD117和CD34阴性有利于平滑肌瘤的诊断.结论 内镜超声检查结合CD117、CD34、SMA和Desmin的联合检测可以提高对梭状细胞形态的间叶性肿瘤的诊断准确性.     

胃肠道平滑肌肿瘤预后因素的探讨

对７０例胃肠道平滑肌肿瘤的预后进行了探讨。按照作者的标准，诊断为良性的肿瘤患者，除２例死于其它疾患外，余者均健在。胃与肠的临界性肿瘤的５年生存率分别为８７％、４０％（Ｐ＜０．０５），胃与肠恶性肿瘤的５年生存率分别为６８％、５０％（Ｐ＞０．０５）。发生腹膜后浸润的肿瘤患者均于术后３９个月内死亡。手术或尸检证实有转移的病例中，２９％发生了淋巴结转移。     

上消化道间叶源性肿瘤临床病理特征46例

目的:观察上消化道间叶源性肿瘤(GIMTs)的临床病理及免疫组化特征,探讨其临床诊断及处置策略.方法:46例内镜超声检查拟诊为上消化道间质瘤的病例,采用光镜观察其手术或黏膜切除术(EMR)标本的病理特征,免疫组化检测其CD117,CD34,平滑肌抗体(SMA)和S-100的表达状况,并分析其病理诊断与临床的关系.结果:46例GIMTs中食管肿瘤占24例,其中间质瘤5例(20.8%),平滑肌瘤19例(79.2%);22例胃GIMTs中间质瘤20例(90.9%),平滑肌瘤1例,神经鞘瘤1例.25例上消化道间质瘤中CD117阳性21例(84%)、CD34阳性24例(96%).而平滑肌瘤与神经鞘瘤分别仅表达SMA和S-100.结论:上消化道间叶源性肿瘤光镜下病理特征相似,联合检测CD117,CD34,SMA和S-100等免疫组化标记物可区别上消化道GIMTs.在食管以平滑肌瘤多见;而在胃则以间质瘤多见,平滑肌瘤与神经鞘瘤非常少见.     

胃平滑肌肿瘤14例报告

胃平滑肌肿瘤发病率低,我们1979年1月1日—1992年12月共收治14例,胃平滑肌瘤与平滑肌肉瘤各7例,均经手术和病理证实,现报告如下。 1 临床资料本组男、女各7例。年龄30—69岁。平均年龄51岁。病史最长8年,最短10天。上腹不适和疼痛9例(64.3％),腹部肿块8例(57.1％),上消化道出血6例     

消化道平滑肌肿瘤20例

目的本文通过对20例消化道平滑肌肿瘤病例进行分析，探讨其临床特点及各类辅助检查的价值方法收集我院自1989－10／1995－03住院患者经手术切除病理确诊的消化道平滑肌肿瘤共20例．结果消化道平滑肌肿瘤主要以腹痛、腹部肿块、消化出血、不完全性肠梗阻为主要症状及体征，无特殊的检查方法．结论消化道平滑肌肿瘤发病率低，临床无特异症状，也无特殊检查方法，诊断困难，术前确诊率低，误诊率高．     

胃肠道平滑肌肿瘤的新认识

近年随着组织化学、免疫组织化学、电镜以及分子生物学技术的发展与应用,已证实以前临床及病理诊断的胃肠道平滑肌肿瘤并不是平滑肌的肿瘤,而是一种非定向分化的间质细胞肿瘤(stromal tumor)。大量研究证明,胃肠道间质细胞瘤远比平滑肌肿瘤多见。     

消化道平滑肌肿瘤216例诊断分析

目的：探讨消化道平滑肌肿瘤的临床特点和诊断方法,以期提高该病的早期诊断常。方法：回顾性分析了我院1964～2002年收治的消化道平滑肌肿瘤216例,均经手术和病理证实。结果：平滑肌瘤(LM)112例,平滑肌肉瘤(IS)104例。消化道出血、腹块、腹痛为胃肠平滑肌肿瘤三大主要临床表现。本组术前诊断率为64．35％,钡餐造影诊断75例,内镜检查诊断80例,超声内镜诊断16例,CT诊断15例,血管造影诊断11例,小肠气钡造影诊断2例。结论：评价诊断方法的选择,钡餐、内镜检查是主要诊断方法;超声内镜、血管造影有重要诊断价值;CT对诊断有很大帮助,尤其对腔外型病变。     

原发性小肠平滑肌肿瘤20例分析

原发性小肠平滑肌肿瘤较少见,临床症状体征无特异性,且无可靠的检查手段,因此误诊率较高.为提高本病的诊断率,本文收集我院1969年至1993年经手术病理证实的小肠平滑肌肿瘤20例进行分析.1 临床资料本组20例平滑肌肿瘤,男性12例,女性8例,年龄18～70岁,以30～60岁居多.其中平滑肌瘤9例,平滑肌肉瘤11例.临床表现病程长短不一,从1天到12年,平滑肌瘤平均病程为2年,平滑肌肉瘤     

胃肠道间质瘤的临床病理分析和免疫组化特点

目的:探讨胃肠道间质瘤(GIST)的临床病理和免疫组化特点．方法:回顾性分析我院收治的24例GIST患者的临床病理及随访资料,并对其石蜡标本采用免疫组化SP染色法检测,分析其免疫组化特点．结果:本组GIST发病年龄29—75(平均54．5±13．5),男16例,女8例,主要发生在胃、小肠、直肠．并多以腹部隐痛不适、腹部肿物、上消化道出血为首发症状,全部患者进行积极外科治疗,肿瘤切除率100％,术后复发转移率为14．3％．大多数病例为手术切除后确诊．肿瘤大小从2-16 cm(平均6．6±3．9 cm)．基本病理组织形态为梭形细胞型,上皮细胞型较少．5例核分裂像>5／50HPF者其肿瘤直径均>5 cm,其中4例伴有囊性变、出血或坏死．4例核分裂像为2-5／50HPF者肿瘤直径在3-5 cm之间．免疫组化染色CD117,CD34,Vim为弥漫强阳性,阳性率分别为91．7％,62．5％和66．7％．S-100阴性, SMA呈灶状阳性．结论:GIST好发于中老年,缺乏特异的临床表现,早期诊断困难,外科手术仍是未转移的GIST的首要治疗方式,并且其肿瘤细胞形态多变,排列方式多样,免疫组化染色为CD117, CD34和Vim阳性,S-100阴性,SMA呈灶状阳性．     

胃肠道间质瘤32例临床病理分析及免疫组化研究

目的：探讨胃肠道间质瘤的临床病理及免疫组化特点和诊断标准。方法：对32例胃肠道间质瘤进行常规病理检查及免疫组化染色。结果：胃肠道间质瘤由梭形细胞和上皮样细胞组成,大多数病例CD117和CD34标记阳性。结论：胃肠道间质瘤是胃肠道常见的非上皮性肿瘤,缺乏定向分化。CD117、CD34标记阳性对胃肠道间质瘤的诊断具有重要的价值。     

胃肠道间质瘤的分子学机制及靶向治疗

C-kit/PDGFRA基因发生功能获得性突变和因此引发的KIT蛋白自主磷酸化是胃肠道间质瘤(gastrointestinal stromal tumors,GISTs)发生过程中最具特征性的分子机制.这一发现使得imatinib靶向治疗GISTs成为可能并取得重大疗效,但研究发现不同类型的GISTs对imatinib治疗的反应也不尽相同,并且随着其临床应用的增加,耐药性及不良反应也随之出现,迫使imatinib临床停药或改为二线用药.因此,GISTs是由不同生物学机制引发的一组疾病,本文就GISTs的分子生物学机制及靶向治疗药物作一综述.     

胃平滑肌肿瘤临床及病理特点

目的 探讨胃平滑肌肿瘤的临床和病理特点。方法 1990年～2002年经我院治疗的胃平滑肌肿瘤41例，对其临床及病理资料等进行分析。随访时间为1～5年。结果 平滑肌肿瘤的主要临床表现为腹痛、体重减轻及上消化道出血，好发部位是胃底和胃体部。内镜下表现为隆起型、溃疡型、浸润型。内镜活检与术后病理符合率为9．8％。平均25个月的随访中，12例死于转移，6例有局部复发。结论 胃平滑肌瘤由于其发病率低临床表现特殊，易造成误诊和漏诊，内镜为诊断GSMT的有效手段，但确诊仍靠病理。肿瘤组织学的恶性程度与局部复发和远处转移明显相关。     

Esophageal mesenchymal tumors： Endoscopy, pathology and immunohistochemistry

AIM： To study the endoscopic, pathological and immunoo histochemical features of esophageal mesenchymal tumors. METHODS： Twenty-nine patients diagnosed as esophageal rnysenchymal tumors by electronic endoscopy and endoscopic ultrasound （EUS） were observed under light microscopes, and all tissues were stained by the immunohistochemical method. The expression of CD117, CD34, SMA and desmin were measured by staining intensity of cells and positive cell ratios. RESULTS： Endoscopically, esophageal gastrointestinal stromal tumors （GISTs） and leiomyomas （LMs） had similar appearances, showing submucosal protuberant lesions. They all showed low echo images originated from the muscularis propria or muscularis mucosa on EUS. Endoscopy and EUS could not exactly differentiate esophageal GISTs from LMs. Microscopically, there were two kinds of cells： spindle cell type and epitheloid cell type in esophageal GISTs. Leiomyomas and leiomyosarcornas were only of spindle cell type. One malignancy was found in five cases of esophageal GISTs, and one malignancy in 24 cases of leiomyomas and leiomyosarcomas. Using Fisher＇s exact method, the differences of malignant lesion proportion were not significant between esophageal LMs and GISTs, 1/5 vs 1/24 （P 〉 0.05）. All cases of esophageal GISTs were positive for CD117, and 3 cases were also positive for CD34. The 24 cases of leiomyomas and leiomyosarcomas were all negative for CD117 and CD34. The differences of positive rates of CD117 and CD34 were significant between esophageal GISTs and LMs, 5/5 vs 0/24, 3/5 vs 0/24 （P 〈 0.005）. All leiomyomas and leiomyosarcomas were positive for SMA, and desmin. Among 5 cases of esophageal GISTs, 2 cases were SMA positive, and 1 case was desmin positive. The differences in positive rates and expression intensity of SMA and desmin were significant between esophageal LMs and GISTs, 24/24 vs 2/5, 24/24 vs 115 （P 〈 0.005）. CONCLUSION： The most common esophageal mesenchymal tumors are leiomyomas, and esophageal GISTs     

Gastrointestinal stromal tumors: thirty years experience of an institution

AIM:To report our experience of gastrointestinal stromal tumors (GISTs) during the last 29 years. METHODS:Thirty two cases of GIST referred to our Institution from the 1st January 1981 to the 10th June 2010 were reviewed. Metastases,recurrence and survival data were collected in relation to age,history,clinical presentation,location,size,resection margins and cellular features. RESULTS:Mean age was 63.7 years (range,40-90) and incidence was slightly higher in males (56%). R0 resection was performed in 90.7%...     

Gastrointestinal stromal tumors of the duodenum:Surgical management and survival results

AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery,Sir Run Run Shaw Hospital(SRRSH)from June1998 to December 2006 were reviewed.All pathological slides were examined by a single pathologist to confirm the diagnosis.In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection,representative paraffin blocks were reassembled,and sections were studied using antibodies against CD117(c-kit),CD34,smooth muscle actin(SMA),vimentin,S-100,actin(HHF35),and desmin.Operative procedures were classified as wedge resection(WR,local resection with pure closure,without duodenal transection or anastomosis),segmental resection[SR,duodenal transection with Roux-Y or BillrothⅡgastrojejunostomy(G-J),end-to-end duodenoduodenostomy(D-D),end-to-end or end-to-side duodenojejunostomy(D-J)],and pancreaticoduodenectomy(PD,Whipple operation with pancreatojejunostomy).R0 resection was pursued in all cases,and at least R1 resection was achieved.Regional lymphadenectomy was not performed.Clinical manifestations,surgery,medical treatment and follow-up data were retrospectively analyzed.Related studies in the literature were reviewed.RESULTS:There were 12 males and 16 females patients,with a median age of 53 years(20-76 years).Their major complaints were"gastrointestinal bleeding"(57.2%)and"nonspecific discomfort"(32.1%).About14.3%,60.7%,17.9%,and 7.1%of the tumors originated in the first to fourth portion,respectively,with a median size of 5.8 cm(1.6-20 cm).Treatment was by WR in 5 cases(17.9%),SR in 13 cases(46.4%),and by PD in 10 cases(35.7%).The morbidity and mortality rates were 35.7%and 3.6%,respectively.The median post-operative stay was 14.5 d(5-47 d).During a follow-up of 61(23-164)mo,the 2-year and 5-year relapse-free survival was 83.3%and 50%,respectively.Eighty-f     

小肠间质瘤的临床特征、诊断与治疗措施

近年来,随着对小肠疾病检出方法的不断完善,对小肠疾病的诊断有了进一步的认识;本文通过比较各种用于小肠肿瘤检出的方法(包括消化道造影、腹部CT、DSA、内窥镜检查、腹部核素扫描、PET等),基本确立小肠间质瘤的诊断流程。再结合临床特征、病理学、以及免疫组化检查,最终确诊小肠间质瘤。手术切除是目前最有效的治疗方法,对于高度怀疑小肠间质瘤的患者,应尽早手术探查;此外,对于不可切除的、复发的、已有转移的间质瘤患者可用伊马替尼治疗。     

Gastrointestinal stromal tumor of appendix incidentally diagnosed by appendiceal hemorrhage

Gastrointestinal stromal tumor is rare, which arises from the mesenchymal tissues in the gastrointestinal tract, and it is extremely rare in the appendix. Only a few cases have been found in this location to date. Although the annual incidence of lower gastrointestinal bleeding has been increasing, bleeding related to the appendix is quite rare. We herein present a very rare case of gastrointestinal stromal tumor incidentally found by appendiceal hemorrhage.     

Midkine as a prognostic marker for gastrointestinal stromal tumors

Purpose Midkine (MK), a heparin-binding growth factor, has an important role in cancer progression. The outcome of patients with gastrointestinal stromal tumors (GISTs) is correlated with tumor size and mitotic count. The aim of this study was to determine MK expression in GISTs. Methods Midkine was detected in 31 (55%) of 57 surgically resected GISTs by immunohistochemistry with a rabbit antibody against MK and peroxidase method. Results A significant worse outcome of MK-positive patients was found (P < 0.05; log rank test). Multivariate Cox regression analysis showed an independent prognostic impact (relative risk for overall survival 3.64; P < 0.05). Interestingly, MK expression was significantly associated with mitotic rate (P < 0.05; Chi-squared test), but not with tumor size (P = 0.97). Conclusions Taken together, MK is a prognostic marker for GIST patients. MK might also be a useful peripheral tumor marker since it can be detected in peripheral serum. Future studies should involve higher GIST patient numbers including tumor and serum samples for detection of MK.