消化系统梭形细胞肿瘤72例临床病理分析

目的探讨消化系统梭形细胞肿瘤的临床病理特点及诊断。方法对72例消化系统梭形细胞肿瘤的临床及病理资料进行复习,应用免疫组化SP法染色。结果 72例消化道梭形细胞肿瘤中,51例为胃肠间质瘤(GIST),其中25例发生在胃,其次是直肠多发,小肠和结肠较少;13例为平滑肌瘤,其中9例发生在食管;4例为炎性肌纤维母细胞瘤(IMT),3例为钙化性纤维性肿瘤(CFT),1例神经鞘瘤。GIST中CD117阳性率为86.4%,CD34阳性率为88.9%,55.6%GIST伴有actin和desmin灶性(+)。10例平滑肌瘤中actin、desmin及caldesmon均(+),而CD117、CD34及S-100均(-)。4例IMT中vimentin均(+),3例actin(+),CD117、CD34、S-100和desmin均(-)。3例CFT中vimentin均(+),1例CD34(+)。神经鞘瘤S-100(+)。结论消化系统梭形细胞肿瘤以GIST最多见,发生在胃最多;其次是平滑肌瘤,发生在食管多见。GIST生物学行为分为4个级别:极低、低、中和高危险度。IMT生物学行为中间型。CD117、CD34、actin、desmin、Ki-67和S-100可作为消化系统梭形细胞肿瘤的常规标记物。

Spindle cell tumors of digestive system:a clinicopathologic analysis of 72 cases

Objective To investigate the clinicopathological immunohistochemical and diagnosis of five spindle cell tumors in system.Methods The clinical and pathological data of 72 digestive system spindle cell tumors patients were reviewed.Immunohistochemical stains were performed on archival paraffin-embedded blocks with strepavidin-peroxidase(SP) method.Results There were 51 GIST cases,13 leiomyoma cases,4 IMT cases,3 CFT cases,1 schwannoma case of all digestive system spindle cell tumors.There were 25 GISTs located in stomach.There were 9 leiomyomas cases in esophagus.GIST expressed CD117(86.4%),CD34(88.9%),actin and desmin(55.6%).All of leiomyomas expressed actin,desmin and caldesmon.All of IMT expressed vimentin.All of CFT expressed vimentin,one of CFT expressed CD34.schwannoma expressed S-100.Conclusion GISTs are the most common tumor of all digestive system spindle cell tumors and usually locate in stomach.Leiomyomas are usually located in esophagus.There were four grades on the behavior of GIST: very low risk,low risk,middle risk,and high risk.IMT belongs to borderline tumor.Application of immunohistochemical markers(CD117,CD34,actin,desmin,S-100,and Ki-67) may be useful in the differential diagnosis.