胃肠道间质肿瘤伴发消化道癌

目的探讨8例胃肠道间质肿瘤（GIST）伴发消化道癌的临床病理特征及免疫表型。方法收集70例GIST中，8例伴发消化道癌的临床和病理资料，并用免疫组化Envision法标记CD117、CD34、Vimentin等。结果伴发消化道癌的8例GIST(4例良性，3例交界性，1例恶性)中，胃腺癌5例，食管鳞状细胞癌2例，结肠腺癌1例。2种病变位于同一器官者4例，位于消化道不同部位4例；2种肿瘤均不相连，术前内镜活检病理诊断腺癌6例，鳞状细胞癌2例，且临床及组织学均未能同时诊断出2种肿瘤。免疫组化标记结果显示：Vimentin、CD34均为阳性8例；CD117阳性7例，阴性1例；S-100灶性阳性2例；SMA、Desmin只有1例小灶阳性表达。结论GIST与消化道上皮性肿瘤同时发生者并不少见，临床应重视对本病的诊断，内镜活检结合术中探查、术后病检有助于本病的早期诊断，进一步提高其柃出率。

Synchronous occurrence of digestive tract cancer and gastrointestinal stromal tumor

Objective To investigate the clinicopathological and immunohistochemical expression in 8 cases with synchronous occurrence of digestive tract cancer and GIST. Methods Clinical and pathologic data of 8 out of 70 cases of GIST coexisted with gastrointestinal cancer were recorded, and immunohistochemical stain ( Envision method) was used to detect the expressions of CD117, CD34 ,Vimenlin etc. Results In 8 cases of GIST (4 benign, 3 borderline, 1 malignant) coexisted with GI carcinoma, of which 6 cases featured the simultaneous occurrence of GIST and adenocarcinomas (5 cases in slomach and 1 case in colon) , whereas the other 2 cases associated with squamus cell carcinoma of esophagus. In 4 cases, tumors arose from the same organ, in the other 4 cases they developed from different sites of digestive tract. In all of the cases two kinds of neoplasms were developed in different areas without any connection, preoperative endoscopy and biopsy showed adenocarcinomas and squamous cell carcinoma, but histologic and clinical diagnosis of coexisted tumors were not achieved in any case. All GIST expressed Vimentin and CD34; 7 cases expressed CD117; 2 cases were focally positive for S-100 protein and 1 each for SMA and Desmin. Conclusion The simultaneous occurrence of epithelial tumor and GIST in digestive tract is not less than that usually expected, in clinical practice we should pay much attention on the diagnosis of this entity. Endoscopic biopsy conjugated with profound inspection during operation and pathological examination of specimen postoperatively can improve the possibility of early diagnosis.