胃肠、泌尿、会阴部间质瘤临床病理及免疫组织化学分析

目的 探讨胃肠道间质瘤(GIST)与胃肠道外GIST型间质瘤的组织学起源与病理特征。方法 对46例胃肠道及13例泌尿道、会阴部原诊断平滑肌瘤、平滑肌肉瘤、许旺瘤的病例作回顾性研究,观察其病理特点,应用免疫组织化学方法观察4种抗体(CD117、CD34、平滑肌肌动蛋白、S—100)的表达,对发生于不同部位的间质瘤进行对比分析。结果 45例为GIST组,CD117阳性表达率为93．3％,CD34阳性率88．9％;12例为胃肠道外GIST型间质瘤组,CDll7阳性表达率为83．3％,CD34阳性率75．0％;2例(其中1例为胃肠道)平滑肌瘤组,CDll7和CD34均为阴性,平滑肌肌动蛋白瘤细胞呈弥漫性强阳性表达。结论 CDll7和CD34标记阳性是确诊间质瘤最具有诊断价值的依据。推测GIST和胃肠道外GIST型间质瘤均系起源于一种非定向分化的、原始间充质干细胞。

Clinicopathological and immunohistochemical analysis of gastrointestinal,urinary and perineal stromal tumors

Objective To study the histogenesis and pathological characteristics of gastrointestinal stromal tumors (GIST) and GIST type stromal tumor (ST) beyond the gastrointestinal tract Methods A retrospective study was carried out on leiomyoma, leiomyosarcoma and neurilemoma (46 cases in gastrointestinal tract and l3 cases in urinary tract and perineal area) 4 antibodies (CD117, CD34, SMA, S 100) were used for immunohistochemical staining Results Among 45 cases of GIST, the positive rate of CD117 and CD34 was 93 3% and 88 9% respectively Among 12 cases of GIST type ST beyond the gastrointestinal tract, the positive rate of CD117 and CD34 was 83 3% and 75 0% respectively In 2 cases (1 in gastrointestinal tract) of leiomyomas, both CD117 and CD 34 were negative in tumor cells, while SMA was extensively positive Conclusions CD117 and CD34 positivity are the most valuable factors in diagnosing ST Both GIST and GIST type ST beyond the gastrointestinal tract are considered originating from a proto interstitial stem cell with disoriented differentiation