上皮样胃肠道间质瘤12例临床病理分析  

Clinicopathological features of epithelioid gastrointestinal stromal tumors:an analysis of 12 cases

作　　者：朱晓静[1] 张新华[1] 周航波[1] 王中秋[1] 周晓军[1] 

机构地区：[1]南京军区南京总医院病理科,南京210002

出　　处：《临床与实验病理学杂志》2010年第2期135-138,共4页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金(30870689);江苏省自然科学基金(BK2008325)

摘　　要：目的探讨上皮样细胞型胃肠道间质瘤(gastrointestinal stromal tumors,GIST)的病理形态、免疫表型特征及鉴别诊断。方法对12例上皮样GIST进行形态观察,免疫组化标记,并结合相关文献进行讨论。结果本组上皮样GIST男女之比为2∶1,平均年龄53.5岁。发生部位包括胃3例,小肠3例,肠系膜2例,网膜3例,腹膜后GIST侵犯肾脏1例。除3例活检小标本外,其余9例肿瘤均完整切除。上皮样GIST镜下形态以圆形、卵圆形或短梭形上皮样细胞为主,瘤细胞中等大小,胞质略嗜酸,细颗粒状。核圆或卵圆形,多为单核,偶见多核细胞。多数病例还可见多少不等的空泡样细胞或核偏位呈印戒样细胞。肿瘤细胞呈器官样构型(4例)、大的片块状构型(3例)、富细胞性构型(4例)及假乳头状构型(1例)。免疫组织化学标记显示绝大多数上皮样GIST表达CD117、CD34或Dog-1,而不表达CK、Syn、Melan-A等。结论上皮样GIST因其细胞形态和组织结构具有上皮性肿瘤的特点而可能与之混淆,CD117和CK免疫标记可明确诊断。Purpose To explore the histological,immunohistochemical characteristics and differential diagnosis of epithelioid gastrointestinal stromal tumors（GIST）.Methods Histology and immunohistochemical markers of twelve epithelioid GIST cases were analyzed and the correlated literature was reviewed.Results The epithelioid GIST of twelve patients had 2 ∶1 male/female ratio with an average age of 53.5（range,29～72 years）.3 cases were located in the stomach,3 in intestine,1 in ileocecal junction,1 in colon,2 in mesentery,3 in omentum and 1 in retroperitoneal which invaded the kidney.Excepting the 3 biopsy specimens,the other 9 patients underwent operation.Microscopically the tumors were composed of middle size of round,oval and short spindle cells with amphophilic cytoplasm that was granular.Clear cytoplasm and signet-ring cells were present in most cases.The tumors assumed organoid,lamellar,hypercellular and pseudo-papilla patterns.Immunohistochemical results showed that majority of the cases expressed CD117,CD34,Dog-1,but did not express CK,Syn and Melan-A.Conclusion Epihtelioid GIST shows epithelioid tumors characteristics in cell shapes and histological patterns,so it is easy to confuse with epithelioid tumors and the tumors origined from epithelial tissues.CD117 and CK immunohistochemical markers are extremely important in the diagnosis.

关 键 词：胃肠道间质瘤 上皮样 CD117 CD34 鉴别诊断 

分 类 号：R735.2[医药卫生—肿瘤]