合并消化系统恶性上皮性肿瘤的胃肠道间质瘤临床病理观察及免疫表型分析

目的分析合并消化系统恶性上皮性肿瘤的胃肠道间质瘤（GIST）临床病理特征及免疫表型。方法以19例合并消化系统恶性上皮性肿瘤的GIST为观察组,回顾分析其临床病理及随访资料,补充完善CD117、CD34、S100、SMA、Ki-67、Cyclin D1和bcl-2免疫表型检测,以同期57例单纯GIST、20例单纯消化系统恶性上皮性肿瘤作对照。结果观察组19例无特异症状,术前GIST均漏诊或误诊;恶性度10例为极低,6例低度,2例中度,1例高度;免疫表型CD117阳性率100%,CD34阳性率84.2%,2例SMA、1例S100灶区阳性,Ki-67指数〈1%、1%～5%和〉5%分别为14例、4例和1例;Cyclin D1阳性5例,bcl-2阳性12例。随访16个月～8年,18例GIST无复发转移,1例胃GIST14个月肝脏转移后2个月死亡。与单纯GIST对照组比较,发病部位、病灶大小、Ki-67指数、核分裂数、危险度及预后差异有统计学意义（P〈0.05）,临床症状、免疫表型差异无统计学意义（P〉0.05）;与单纯癌对照组比较,临床症状、预后差异无统计学意义（P〉0.05）。结论消化系统恶性上皮性肿瘤伴发的GIST大部分在手术探查时发现,危险度以极低度、低度为主,比单发的GIST恶性程度低,预后主要与消化系统恶性上皮性肿瘤有关。

Clinical pathology observation and immunohistochemistry study of coexistence of gastrointestinal stromal tumors with other primary gastrointestinal carcinoma

Objective To investigate the clinical and immunohistochemistry characteristics of coexistence of gastrointestinal stromal tumors（GIST） with other primary gastrointestinal carcinoma.Methods The clinical,immunophenotypic and histopathologic features of 19 cases GIST complicating with gastrointestinal carcinoma were retrospectively studied.The expression of CD117,CD34,S100,SMA,Ki-67,Cyclin D1 and bcl-2 was detected by S-P method in 19 cases GISTs and they were compared to the synchronic 57 patients with only GIST and 20 patients with only gastrointestinal carcinoma.Results In the group of 19 patients with GIST,none of the GISTs complicating with gastrointestinal carcinoma had got final diagnosis or suspected diagnosis before operation.The number of patients at extremely low,low,moderate,and high risk was 10,6,2 and 1.The positive rate of CD117,CD34,S100,SMA,Cyclin D1 and bcl-2 was 100%,84.2%,5.3%,10.5%,26.3% and 63.2% .The number of patients of Ki-67 LI 〈 1%,1% ～ 5% and 〉 5% was 14,4 and 1.All cases were at follow-up for 16 months ～ 8 years.Among them 18 had no recurrence or metastasis and 1 died of the tumor metastasis to the liver after 16 months.There were difference for the disease site,tumor size,Ki-67 LI,mitotic number,risk stratification and prognosis and no difference for the clinical symptoms and immunohistochemical phenotype between the complicating GIST or not.Conclusions The most coexistences of GIST were found by chance in operation for gastrointestinal carcinoma.Coexistencesof GIST with gastrointestinal carcinoma are often very low or low risk GIST,and risk scales are lower compared with simple GISTs.The prognosis of patients relate to coexistence gastrointestinal carcinoma