胃肠道间质瘤的临床病理研究

目的；研究胃肠道间质瘤（GIST）的临床病理及免疫组化特点。方法：回顾性观察57例胃肠道间质瘤HE染色切片，并复习临床病理资料，采用vimentin、SMA、S-100、CD34四种单克隆抗体，对每例肿瘤组织进行了免疫组化染色。结果：57例胃肠道间质瘤中，发生于胃26例，小肠28例，结肠3例，其中良性28例，恶性26例，境界性3例；免疫组化标记，vimentin阳性率100%，CD34阳性率86%，SMA阳性率45.6%，S-100阳性率31.6%，除S-100蛋白外，vimentin、SMA、CD34在不同部位的GIST或良恶性GIST之间并无明显差异，正常胃肠肌层及对照组的CD34标记均为阴性。结论：胃肠道的梭形细胞肿瘤大多为间质瘤，免疫组化特征为CD34阳性，并可同时部分表达肌源性及神经源性标记物，而良、恶性的鉴别主要根据肿瘤的大小、生长方式及核分裂的多少而定。

A clinicopatholoyic study of gastriointestinal stromal tumors

Objectives:To investigate the clinicopathologic and immunohistochemical features of gastrointestinal stromal tumors (GISTs). Methods:The clinical and pathological data as well as H E stained slides of 57 cases of GISTs were reviewed. The immunoexpression of vimentin,smooth muscle actin(SMA),S 100 protein,and CD34 were determined in all cases with SP method. Results: 26 tumors were located in the stomach, 28 in the small intestine, and 3 in the colon.Histologically, 28 cases were benign GISTs, 26 cases malignant,3 cases borderline.Immunohistochemically,the positive rate for vimentin was 100 percent;CD34, 86 percent;SMA, 45.6 percent;and S 100 protein, 31.6 percent.Excepting S 100 protein,there were no obviously different immunoreactivity for vimentin,SMA,and CD34 among different location or between benign and malignant GISTs.The muscular layer of gastrointestinal tract and control group were CD34 negative reactivity. Conclusions: Most spindle cell tumors of gastrointestinal tract are GISTs. Its immunohistochemical feature is CD34 postive reaction,and may also co express muscular marker (SMA) and neural marker (S 100 protein).The differentiation between benign and malignant GISTs mainly depends on the tumor size,its clinical behavior,and the number of mitosis.