胃肠道间质瘤CD117、CD34、SMA、S-100蛋白、Vim、结蛋白的表达及临床意义

目的 探讨胃肠道间质瘤(GISTs)的临床病理诊断,以及CD117、CD34、SMA、S-100蛋白、波形纤维蛋白(Vim)、结蛋白表达的临床意义.方法 回顾分析了35例手术后经病理确诊的GISTs临床资料及辅助检查结果.免疫组化检测肿瘤组织CD117、CD34、SMA、S-100蛋白、Vim、结蛋白等抗原标志物的表达,分析对GISTs的诊断意义.结果 35例GISTs发生于胃11例、小肠11例、腹腔5例.主要临床表现有腹胀、腹痛、消化道出血、腹部肿块.肿瘤组织中CD117、CD34的阳性表达率分别为94.3%和91.4%,显著高于SMA、S-100蛋白、Vim、结蛋白的表达(P<0.001),也显著高于在平滑肌瘤中的表达(P<0.0001);GISTs中结蛋白的阳性表达率2.9%,显著低于CD117和CD34(P<0.05);也显著低于在平滑肌瘤中的表达(P<0.001).结论 GISTs多发生于胃和小肠,胃肠镜、超声内镜和CT检查对间质瘤有较大诊断价值.而CD117阳性、CD34阳性及结蛋白结蛋白阴性对GISTs有确诊意义.

Expression of CD117, CD34, SMA, S-100 protein, Vim and desmin in patients with gastrointestinal stromal tumors

OBJECTIVE: To investigate the clinicopathological diagnosis and expressions of CD117, CD34, SMA, S-100 protein, Vimentin(Vim) and desmin in gastrointestinal stromal tumors (GISTs). METHODS: A retrospective analysis of the clinical data and the results of various examinations was conducted among 35 patients with pathologically confirmed GISTs undergoing surgical resection. The expressions of CD117, CD34, SMA, S-100, Vim and desmin in the tumor tissues were detected by immunohistochemistry with SP method. RESULTS: In these GIST cases, the tumors were located mostly in the stomach (n=11), small intestines (n=11), and abdominal cavity (n=5). The main clinical manifestations included abdominal distension, abdominal pain, gastrointestinal bleeding, and abdominal masses. The positivity rates of CD117 and CD34 in the tumors were 94.3% and 91.4%, respectively, both significantly higher than those of SMA, S-100, Vim and Desmin (P<0.001), and also higher than that in leiomyoma (P<0.0001). The positivity rate of Desmin was only 2.9% in the tumors, significantly lower than those of CD117 and CD34 (P<0.05) and that in liomyoma (P<0.001). CONCLUSIONS: GISTs occur mostly in the stomach and small intestines, and endoscopy, ultrasound endoscope and CT examination are effective modalities for diagnosis of GISTs. A definite diagnosis of GISTs can be established in the presence of positive expression of CD117 and CD34 and negative expression of Desmin in the tumor.