与癌并发的胃肠道间质瘤临床病理观察  

Clinicopathologic features of gastrointestinal stromal tumor with synchronous carcinoma

作　　者：孙希印 吴起嵩[2] 耿振宏[3] 李青 王琳琳 李新功 

机构地区：[1]山东省东营市人民医院病理科,257091 [2]胜利油田中心医院病理科 [3]胜利石油管理局胜利医院病理科

出　　处：《中华病理学杂志》2013年第11期739-743,共5页Chinese Journal of Pathology

摘　　要：目的 分析与消化道癌并发的胃肠道间质瘤（GIST）的临床病理特点并探讨其处理原则.方法 复习山东省东营市人民医院、胜利油田中心医院、胜利石油管理局胜利医院3所医院2002年1月至2008年12月收检的113例GIST病例,观察并发胃肠道癌病例（19例）的临床病理特点,与未并发胃肠道癌的病例（94例）进行比较.结果 113例中并发胃肠道癌者19例,占16.8％.其中男11例,女8例,男女之比为1.38∶1.00.年龄43 ～ 66岁,中位年龄57岁.19例中位于食管下段者5例,位于胃壁14例,肿瘤直径0.6 ～ 3.8 cm,平均（1.91±0.92）cm,3例有轻度异型性,其余无异型性.核分裂象数0 ～ 4/50 HPF,平均（0.74±1.07）/50 HPF,Ki-67阳性指数0～ 7.72％,平均（2.51±2.20）％.并发癌瘤包括食管癌2例,胃癌17例.作为对照,未并发胃肠道癌者94例,男52例,女42例,男女之比为1.24∶1.00.年龄43 ～ 71岁,中位年龄55岁.79例发生于胃,10例位于肠,5例发生于食管.肿瘤直径2.4～15.5 cm,平均（5.42±6.17）cm.79例显示不同程度的异型性,12例具有高度恶性潜能.核分裂象数0 ～ 53/50 HPF,平均（3.78±10.22）/50 HPF.Ki-67阳性指数0 ～ 37.54％,平均（6.78±12.45）％.并发癌的GIST与未并发癌者比较,男女比值较高,瘤体平均直径较小,细胞异型性小,核分裂象数和Ki-67阳性指数均较低（分别为t’=2.809,P＜0.05;t’=3.095,P＜0.05）.结论 16.8％的GIST并发癌.与癌并发的GIST多数没有特殊临床症状,多因癌手术后大体检查发现,其增殖活性显著低于未并发癌的GIST,多数不需要针对性治疗,当肿瘤具有恶性指征时采用恶性GIST治疗规范.Objective To evaluate the clinicopathologic features of gastrointestinal stromal tumor （GIST） with synchronous carcinoma and the treatment principle.Methods Nineteen cases of GIST with synchronous carcinoma were collected from 113 cases of GIST from 2002 to 2008.The clinicopathologic features were studied and the expression of CD117,CD34,smooth muscle actin and S-100 protein were detected by immunohistochemistry using EliVision method.The expression of proliferation marker Ki-67 was also studied.GIST with synchronous carcinoma and those without carcinoma were compared.Results Nineteen cases （16.8％） of GIST with synchronous carcinoma were found,including 11 males and 8 females （male to female ratio 1.38∶ 1.00）.The age of the patients ranged from 43 to 66 years （median age 57 years）.Five of 19 cases were located in the inferior segment of esophagus and 14 were in the gastric wall.The diameter ranged from 0.6 to 3.8 cm [mean （1.91 ±0.92） cm].Three of 19 cases showed low grade dysplasia,and there was no dysplasia in the remaining 16 cases.The number of mitosis ranged from 0 to 4/50 HPF [mean （0.74 ± 1.07）/50 HPF].The Ki-67 proliferative index （number of Ki-67 positive cell/HPF） ranged from 0 to 7.72％ [mean （2.51 ± 2.20）％].The synchronous carcinomas included two esophageal carcinomas and 17 gastric cancers.In contrast,patients of GIST without carcinoma included 52 males and 42 females （male to female ratio 1.24∶1.00）.The age of patients ranged from 43 to 71 years （median age 55 years）.Seventy-nine of the 94 cases were located in the stomach,10 were in the intestine and 5 were in the esophagus.The diameter ranged from 2.4 to 15.5 cm [mean （5.42 ± 6.17） cm].Seventy-nine of the 94 cases showed variable degrees of dysplasia,and 12 cases were of high malignant potential.The number of mitosis ranged from 0 to 53/50 HPF [average （3.78 ± 10.22）/50 HPF].The Ki-67 proliferative index ranged from 0 to 37.54％ [mean （6.78 ±0 12.45） ％].Comparing these two group

关 键 词：胃肠道间质肿瘤 肿瘤 多原发性 诊断 鉴别 

分 类 号：R735[医药卫生—肿瘤]