原发胃肠外间质瘤的诊断与治疗  

The diagnosis and treatment for primry extragastrointestinal stromal tumor

作　　者：张德巍[1] 杨大业[1] 关维雨[1] 李永双[1] 

机构地区：[1]中国医科大学附属第四医院急诊外科,辽宁沈阳110032

出　　处：《现代肿瘤医学》2013年第2期363-367,共5页Journal of Modern Oncology

基　　金：辽宁省自然科学基金(编号:20102260)

摘　　要：目的:探讨胃肠外间质瘤(EGISTs)的病理特征、免疫组化表达与临床特点,研究胃肠外间质瘤的诊断要点及治疗方法。方法:回顾性分析我院2000年1月至2011年12月收治的EGISTs患者的临床资料、组织学、免疫组化表达及预后。结果:8例EGISTs患者平均年龄59.9岁,临床上以腹部肿块伴疼痛为主,偶见胃肠道症状。肿瘤平均直径为16.2cm,细胞类型以梭形细胞多见。核分裂数4例﹤5个/50HPF,2例﹤10个/50HPF,2例﹥10个/50HPF,肿瘤中心坏死6例。免疫组化CD117阳性8例、CD34阳性5例、SMA阳性2例、S-100阳性1例。2例患者术后因肿瘤复发和转移死亡,1例患者带病生存,1例失访,余4例患者随访期间肿瘤无复发、转移。结论:EGISTs好发于中老年,具有胃肠间质瘤(GISTs类似的病理特征与免疫表型。恶性潜能高,预后差;瘤体直径>5 cm、核分裂数>2个/50HPF、瘤细胞密度高和坏死是诊断恶性的主要指标。治疗以手术切除为主,对于中、高风险患者术后应给予伊马替尼等靶向治疗。Objective： To explore the pathological, immunohistochemical clinical feature and the diagnosis and treatment of extragastrointestinal stromal tumors （EGISTs）. Methods： Eight patients with EGISTs were admitted, and accepted operation. We retrospectively analysed the clinical data, pathological feature, immunohistochemical expression and the prognosis of the eight patients. Results： The average age of the 8 patient was 59.9 years. The mainly complain was abdominal mass and pain,anti the gastrointestinal symptnm occasionally exist. The average diameter of the mass was 16.2cm. Microscopically,the spindle celi was often presented. On mitotic activity ,4 cases 〈 five mitosis per 50 high - power fiehls（HPF） ,2 cases 〈 ten mitosis per 50 high - power ileitis（HPF） ,2 eases 〉 ten mitosis per 50 high - power fields（IIPF） .6 eases showed central necrosis. On immunohistochemistry, the neoplastic cells expressed C D117 （ 8 cases）, CI）34 （ 5 cases ）, smooth muscle actin （ 2 cases ）, and S - 100 protein （ I case）. In the fi）lh）w -up period two patients died of tumor recurrence and metastasis,tm~~ patient prcsented with adverse event, others without recutTence aad metastasis. Conclusion：EGISTs minly occur in aduh people, has the similar character with gastrointestinal stromal tumors. The diameter, mitotic activity, necrosis focus are the index for the degree of malignancy. The treatment is mainly by reseeted,imatinib targeted therapy should be used for the cases with insufficient data and high risk for malignancy.

关 键 词：胃肠间质瘤 胃肠外间质瘤 CD117 诊断 治疗 

分 类 号：R735.2[医药卫生—肿瘤]