上消化道间叶源性肿瘤临床病理特征46例

目的:观察上消化道间叶源性肿瘤(GIMTs)的临床病理及免疫组化特征,探讨其临床诊断及处置策略.方法:46例内镜超声检查拟诊为上消化道间质瘤的病例,采用光镜观察其手术或黏膜切除术(EMR)标本的病理特征,免疫组化检测其CD117,CD34,平滑肌抗体(SMA)和S-100的表达状况,并分析其病理诊断与临床的关系.结果:46例GIMTs中食管肿瘤占24例,其中间质瘤5例(20.8%),平滑肌瘤19例(79.2%);22例胃GIMTs中间质瘤20例(90.9%),平滑肌瘤1例,神经鞘瘤1例.25例上消化道间质瘤中CD117阳性21例(84%)、CD34阳性24例(96%).而平滑肌瘤与神经鞘瘤分别仅表达SMA和S-100.结论:上消化道间叶源性肿瘤光镜下病理特征相似,联合检测CD117,CD34,SMA和S-100等免疫组化标记物可区别上消化道GIMTs.在食管以平滑肌瘤多见;而在胃则以间质瘤多见,平滑肌瘤与神经鞘瘤非常少见.

Clinical and pathological characteristics of upper gastrointestinal mesenchymal tumors: An analysis of 46 cases

AIM:To study the clinical,pathological and immunohistochemical characteristics of upper gastrointestinal mesenchymal tumors (GIMTs), so as to provide guidance for clinical diagnosis and treatment. METHODS:Forty-six cases of upper GIMT were clinically diagnosed by endoscopic ultrasonogra- phy (EUS).The samples obtained by surgery or endoscopic mucosal resection were observed by pathological sectioning and staining.The expres- sion of CD117,CD34,smooth muscle antibodies (SMA) and S-100 was assayed by immunohisto- chemical staining. RESULTS:Twenty-four of the 46 GIMTs were esophagus mesenchymal tumors,5 of which were stromal tumors (20.8%) and 19 were leio- myomas (79.2%).Twenty-two of the 46 tumors were gastric mesenchymal tumors,which in- cluded 20 stromal tumors (90.9%),1 leiomyoma and 1 neurilemmoma.Twenty-one of the 25 up- per gastrointestinal stromal tumors were CD117 positive (84%) and 24 were CD34 positive (84%). SMA and S-100 were expressed only in leiomyo- ma and neurilemmoma,respectively. CONCLUSION:The pathological characteristics of upper GIMTs are similar by microscopic ob- servation,and can be differentiated by combined assay of some immunohistochemical markers such as CD117,CD34,SMA and S-100.Most esophagus mesenchymal tumors are leiomyo- mas,and most gastric mesenchymal tumors are stromal tumors.Leiomyoma and neurilemmoma are rare.