胃肠道间质瘤39例临床病理分析

目的:探讨胃肠道间质瘤(gastrointestinal stromal tumors,GISTs)的临床病理特点及诊断,鉴别诊断要点。方法:结合HE片及免疫组化CD117、CD34、S-100、SMA回顾性分析本院2006年3月～2009年12月39例GISTs病例的临床特征及病理形态改变。结果:本组39例GISTs中潜在恶性12例,10例低度恶性,17例高度恶性。潜在恶性组肿瘤直径小于3 cm,细胞无异型性,核分裂少见,无明显出血、坏死。恶性肿瘤组可见出血坏死,细胞丰富,异型性明显,核分裂多见。免疫组化表型:酪氨酸激酶受体CD117阳性35例,骨髓干细胞抗原CD34阳性29例,可溶性酸性蛋白S-100阳性8例,平滑肌肌动蛋白SMA阳性13例。结论:GISTs主要发生在胃和小肠。CD117和CD34阳性标记是确诊GISTs最有价值的免疫标记物。GISTs的恶性程度与肿瘤大小、细胞异型性、核分裂数密切相关,细胞增殖活性Ki-67指数增高,肿瘤的恶性程度亦增高.

Clinical and pathological features of gastrointestinal stromal tumors:a report of 39 cases

Objective： To explore clinical and pathological features of gastrointestinal stromal tumors（GISTs） and to probe the key points of diagnosis and differential diagnosis.Methods： The GISTs clinical features and pathological morphological changes of 39 cases from March 2006 to December 2009 in our hospital were analyzed retrospectively.HE staining method and immunohistochemical method were used to investigate CD117,CD34,S-100 and SMA.Results： Among the 39 cases,12 cases were of potentially malignant,10 cases were of low degree malignant,17 cases were of high degree malignant.The diameters of potentially malignant tumor were less than 3 cm without different types of cells,and with rare nuclear fission.And no obvious hemorrhage and necrosis occurred.Malignant tumor group showed hemorrhage,necrosis,rich cell,clear atypia and more common mitotic.Immunohistochemical test showed tyrosine kinase receptor CD117-positive,bone marrow stem cell antigen CD34-positive in 29 cases,soluble acidic protein S-100 positive in 8 cases,smooth muscle actin SMA-positive in 13 cases.Conclusions： CD117 and CD34 are the most valuable immune markers in diagnosing GIST.The degree of GIST malignant tumor closely correlates with the size,cell atypia,necrosis and mitotic number.The extent of malignancy increases when the proliferation Ki-67 index of the cell gets higher.