直肠间质瘤16例临床病理分析

目的 探讨直肠间质瘤的免疫组化特征和临床诊治经验。方法 对20例直肠间叶组织肿瘤进行CD117等免疫组化染色,对其中16例直肠间质瘤的免疫表型、临床资料及随访结果进行分析。结果 确诊直肠间质瘤16例,直肠平滑肌肉瘤3例,直肠神经鞘瘤1例。间质瘤组中良性2例、交界性1例、恶性13例,CD117和CD34的表达率分别为100％(16／16)和88％(14／16);直肠间质瘤患者,平均发病年龄为60岁,首发症状主要为排尿排便困难(38％)和腹痛(31％),14例(88％)肛诊阳性;术后1、3、5年生存率分别为89％、64％、48％,术后平均生存时间为47个月。结论 直肠间质瘤是最常见的直肠间叶源性肿瘤,生物学行为常表现为恶性,易局部浸润和术后复发,早期诊断、根治性切除和及时发现复发是改善预后的关键。

Rectal stromal tumors: a clinicopathological study of 16 cases

Objective To investigate the clinical diagnosis,treatment and immunohistochemical characteristics of rectal stromal tumors. Methods Immunohistochemical expression of CD117 was retrieved in 20 cases of mesenchymal tumors of the rectum. And we analyzed the immunohistochemical characteristics, clinical data of rectal stromal tumors, and the results retrospectively. Results Sixteen cases of rectal stromal tumors, 3 cases of leiomyosarcomas and 1 case of schwannoma were diagnosed. Histologically,2 cases of GISTs were classified as benign,1 as borderline and 13 as maliganant.All of rectal stromal tumors(100%) were strongly positive for CD117, and 14 cases(88%) positive for CD34 The demographic profile of rectal stromal tumors showed a male predominance with average age of 60 years old.The main symptoms were urinary retention,constipation and abdominal pain.14 cases were positive in digital rectal examination.The recurrence rate of local and radical resection in malignant stromal tumors was 4/4 and 3/6.1,3,5 year survival rates were 89%?64%?48%, respectively. After operation mean survival time of was 47 months. Conclusions The specific GIST constituted the majority of mesenchymal tumors in rectum.It usually showed malignant biological behavior. Invasion and recurrence were common.Earlier diagnosis and radical resection had better prognosis. Periodically following up can help to detect the recurrence timely.