胃肠道间质瘤20例诊治分析及文献复习  

Clinical Analysis of 20 Cases with Gastrointestinal Stromal Tumors and Review of the Literature

作　　者：李本全[1] 李发强[1] 王道军[1] 刘阿海[1] 靳桂红[1] 王占成[1] 

机构地区：[1]河南省焦作煤业集团中央医院肿瘤内科,454000

出　　处：《实用癌症杂志》2008年第4期366-368,共3页The Practical Journal of Cancer

摘　　要：目的探讨胃肠道间质瘤（GIST）的临床病理、免疫组化特点、鉴别诊断和治疗现状。方法对20例GIST患者的临床资料进行回顾性分析。结果GIST常以腹痛、腹胀、腹部不适、腹部包块、消化道出血为首发症状;20例GIST中恶性15例,交界性2例,良性3例;发生在胃肠道者17例,发生于胃肠道外3例;抗体表达情况：CD117 95.0%、CD34 65.0%、Vimentin 100.0%、SMA20.0%阳性,S-100全部阴性。20例均行手术切除治疗,2例恶性间质瘤术后辅助化疗生存21个月、30个月,另2例恶性间质瘤术后复发应用格列卫（STI571）治疗,生存3年;3例良性者术后无复发生存2-7年;2例交界性术后分别生存10个月、7年。结论GIST的临床表现无特异性;CD117、CD34、S-100和SMA联合检测可协助诊断;细胞密集、明显核异形、肿瘤性坏死及核分裂数〉5/50HP可作为恶性参考指标;以手术切除为主的综合治疗是可靠的治疗方法,传统放化疗可作为晚期或术后复发GIST的姑息治疗手段。STI571是治疗术后复发及不能手术切除GIST的有效药物,并能改善其预后。Objective To investigate the clinicopathological,immunohistochemical characteristics,and to update the differential diagnosis and treatment of qastrointestinal stromal tumors（GIST）.Methods The clinical data of 20 patients with GIST was analyzed retrospectively.Results The first symptom of GIST was often abdominal pains,abdominal distention,malaises in the abdomen,abdominal mass and gastrointestinal bleeding.15 cases were malignant,2 cases were juncture and 3 cases were benign in 20 cases.Tumors were located in the qastrointestinal tract in the 17 cases,and 3 cases were in extra-qastrointestinal tract.Tumors expressed CD117 95.0%（19/20）,CD34 65.0%（13/20）,Vimentin100.0%（20/20）,SMA20.0%（4/20）,S-100 0.0%（0/20）.20 patients received tumor resections.2 cases of malignant GIST survived 21 months and 30 months respectively with chemotherapy in post-operation,2 cases of malignant GIST survived 3 years by STI571 after operation,3 cases of benign GIST survived 2-7 years after operation,2 cases of juncture survived 10 months and 7 years respectively.Conclusion Presenting features of GIST was no specific.Application of immunohistochemical markers（CD117,CD34,SMA,S-100） may be useful in the differential diagnosis.High cellularity,obvious nuclear atypia,tumor coagulative necrosis and mitoses over 5/50HP are malignant parameters.Surgical resection with adjunctive therapies is effective way for it.STI571 is confirmed to be effective against recurrent,metastatic or unresectable GIST and improve prognosis of it.

关 键 词：胃肠间质瘤 诊断 治疗 预后 

分 类 号：R730.262[医药卫生—肿瘤]