162例胃肠道间质瘤的临床病理学及免疫表型特征

目的阐明胃肠道间质瘤的临床病理学与免疫表型特征。方法收集１６２例胃肠道间质瘤临床病理学资料,其中４６例进行免疫组织化学染色。标记抗体为波形蛋白（ｖｉｍｅｎｔｉｎ）、ＣＤ３４、肌特异性肌纤蛋白（ＭＳＡ）、平滑肌特异性肌纤蛋白（ＳＭＡ）、Ｓ１００蛋白、神经特异性烯醇化酶（ＮＳＥ）、突触素（ＳＹＮ）、细胞角蛋白（ＣＫ）、癌胚抗原（ＣＥＡ）、白细胞共同抗原（ＬＣＡ）等１０种抗体。结果病理学上肿瘤起源于胃肠道肌层,直径为０．５～４３ｃｍ,５５％为恶性。免疫表型特征为ｖｉｍｅｎｔｉｎ,占１００％、ＣＤ３４,占６４％、ＭＳＡ,占４７％、ＳＭＡ,占４１％、ＮＳＥ,占６１％、Ｓ１００蛋白,占１９％、ＳＹＮ,占１５％。胃肠道间质瘤不表达ＣＫ、ＣＥＡ、ＬＣＡ。结论间质瘤为起源于胃肠道肌层的最常见间叶性肿瘤,消化道出血与腹部包块为最常见症状。最常见的细胞学特征为梭形细胞和上皮样细胞。肿瘤的大小、核分裂相是关系到肿瘤良恶性和患者预后、生存的最重要因素。免疫组化证实仅有部分肿瘤具有不完全的平滑肌、神经或双向分化特征。

The clinicopathological and immunophenotypical features of 162 cases of gastrointestinal stromal tumor

OBJECTIVE: To demonstrate the clinicopathological and immunophenotypical features of gastrointestinal stromal tumor (GIST). METHODS: One hundred and sixty-two cases of GIST were retrospectively studied. Among them, forty-six cases were immunostained using antibodies against vimentin, CD34, muscle specific actin (MSA), smooth muscle actin (SMA), neuron specific enolase(NSE), S-100 protein, synaptophysin (SYN), cytokeratin(CK), CEA, LCA. RESULTS: Clinically, male patients predominated with a male to female ratio of 3.8:1. The average age was 50 (range 6-74). The most common symptoms were gastrointestinal bleeding and abdominal mass in 45% and 39% of the cases, respectively. The common anatomical locations were stomach (43%), ileum (20%), jejunum (18%). Pathologically, all the tumor arose from the muscular layer. The tumor diameter varied from 0.5 to 43 cm. In 55% of the cases, the tumor was malignant. The main component cell types were spindle and epithelioid in appearance. Immunophenotypically, percentage of positivity for the 10 antibodies was as follows: vimentin, 100% (39/39), CD34, 64% (23/36), MSA, 47% (16/34), SMA, 41% (14/34), NSE, 61% (17/28), S-100 protein, 19% (4/21), SYN, 15% (3/20), CK, CEA, and LCA were negative. CONCLUSION: GIST is the most common mesenchymal tumor of the gastrointestinal tract. Immunostaining confirms that only some of the GIST shows partial differentiation toward smooth muscle, neuron, or both.