胃肠道间质瘤19例临床病理分析

目的:探讨胃肠道间质瘤(gastrointestinalstromaltumors,GIST)的临床病理、免疫组化特征、鉴别诊断和治疗方法。方法:应用光镜观察形态特征,应用免疫组化SP法对胃肠道和胃肠外腹腔内原诊断为平滑肌瘤、平滑肌母细胞瘤和平滑肌肉瘤24例检测CD117、CD34、Vimentin、SMA和S100,获得19例GIST。结果:19例GIST占同期消化系统间叶肿瘤的79.2%(19/24)。抗体表达情况:CD11794.7%(18/19)、CD3463.2%(12/19)、Vimentin100%(19/19)、SMA15.8%(3/19)阳性和S100表达全部阴性。结论:GIST是消化道最常见的间叶性肿瘤。CD117、CD34、SMA和S100联合使用可协助鉴别诊断GIST。细胞密集、明显核异形、肿瘤性坏死以及核分裂数>5/50HP可作为恶性参考指标,手术切除是主要的治疗方式。

Clinicopathologic study on 19 cases of gastrointestinal stromal tumors

OBJECTIVE:To study clinicopathology and immunohistochemical features of gastrointestinal stromal tumors (GISTs),and their differential diagnosis and treatment. METHODS: The clinicopathologic characteristics of GISTs were studied by using light microscopy (a panel of antibodies such as CD_ 117,CD_ 34,Vimentin,SMA,and S-100 protein were detected by SP in 24 cases), which were previously diagnosed as leiomyoma, leiomyoblastoma, or leiomyosarcoma etc.RESULTS: Nineteen cases of GIST were equivalent to 79.2% (19/24) of all mesenchymal tumors of gastrointestinal tract in the same period.Tumors expressed CD_ 11794.7%(18/19),CD_ 3463.2%(12/19),Vimentin100%(19/19),SMA15.8%(3/19),S-100(0/19). CONCLUSIONS: GIST is the most frequent mesenchymal tumor of gastrointestinal tract. Application of immunohistochemical markers ( CD_ 117, CD_ 34, SMA and S-100 ) contribute to differential diagnosis. High cellularity, obvious nuclear atypia,tumor coagulative necrosis and mitoses over 5/50HP are malignant parameters. Surgical resection is mainly treatment.