胃肠间质瘤的临床病理分析

目的探讨胃肠间质瘤（gastrointestinal stromal tumors，GIST）的诊断和治疗。方法回顾性分析50例GIST的临床表现、影像学及病理、免疫组织化学特征，用GIST Fletcher风险分级对原发GIST进行分析诊断。结果50例GIST平均年龄47岁，40岁以上者占80％。发生于胃13例，十二指肠5例，小肠17例，结肠5例，直肠及肛门2例，胃肠道外8例；其中1例有淋巴结转移。肿瘤组织中CD117、CD34的阳性表达率分别为80％和50％，显著高于SMA、S-100蛋白、Vimentin、Desmin的表达；GIST中Desmin的阳性表达率为12％，显著低于CD117和CD34。本组恶性程度为高度风险18例（36％），中度风险12例（24％），低度风险17例（34％），极低度风险3例（6％）。结论CD117阳性、CD34阳性对GIST有确诊意义。GIST Fletcher风险分级诊断对临床治疗及预后有重要的指导作用。

Clinicopathological Analysis of Gastrointestinal Stromal Tumors

Objective To explore the diagnosis and treatment of gastrointestinal stromal tumor(GIST).Methods The clinical manifestations,imaging,pathology and immunohistochemical features of 50 patients with GIST were retrospectively analyzed.Risk classifications of primary GIST were analyzed and diagnosed by GIST Fletcher Risk Ranking.Results The mean age of the 50 patients with GIST was 47 years,and patients over 40 years of age accounted for 80%.13 patients’ lesions were in stomach,5 in duodenum,17 in small intestine,5 in colon,2 in rectum and anus and 8 outside gastrointestinal tract;and among them,1 patient had lymph node metastasis.The positive expression rates of CD117 and CD34 in tissues of tumor were 80% and 50% respectively significantly higher than that of SMA,S-100,Vimentin and Desmin.The positive expression rate of Desmin in GIST was 12% significantly lower than that of CD117 and CD34.The risk rankings of malignancy in the group were 18 patients with high risk(36%),12 patients with moderate risk(24%),17 patients with low risk(34%) and 3 patients with very low risk(6%).Conclusion Final diagnosis of GIST can be established in the positive expression of CD117 and CD34.GIST Fletcher risk classification diagnosis plays an important role in clinical treatment and prognosis.