胃肠道间质瘤76例的临床病理及免疫组织化学特征  

A clinicopathologic and immunohistochemical study on 76 cases of gastrointestinal stromal tumors

作　　者：侯英勇[1] 王坚[1] 朱雄增[1] 杜祥[1] 孙孟红[1] 郑爱华[1] 

机构地区：[1]复旦大学附属肿瘤医院病理科,上海200032

出　　处：《中华病理学杂志》2002年第1期20-25,共6页Chinese Journal of Pathology

基　　金：上海市科委基金资助项目 (9741190 2 5 )

摘　　要：目的　探讨胃肠道间质瘤 (GIST)的临床表现、病理组织形态学和免疫组织化学特点及良恶性参考指标。方法　用CD117、CD34等抗体 ,通过免疫组织化学EnVision法对原发性消化道间叶源性肿瘤进行研究 ,确诊 76例GIST ,并结合随访资料 ,对其生物学行为进行分析。结果　本组GIST均为成年人 ,年龄 32～ 81岁 (平均 5 4岁 ) ,男性 39例 ,女性 37例 ,发生于胃 34例 ,小肠 2 3例 ,结肠 2例 ,直肠 17例 ,最常见症状为腹部肿块、腹部胀痛不适及消化道出血。黏膜下生长者 3例 ,浆膜外生长者 2 5例 ,余 4 8例主要位于肌壁。大体上 ,肿瘤较易出现出血、坏死、囊性变等继发性改变。镜下观察 ,梭形细胞型 4 6例 ,上皮样细胞型 9例 ,梭形 /上皮样细胞混合型 2 1例 ,呈交叉束状、弥漫片状、栅栏状、漩涡状、小巢状、器官样及假菊形团样排列 ,瘤细胞胞质空亮、淡伊红、轻至中度嗜伊红及略嗜碱 ,核梭形、卵圆、圆形或镰状。CD117和CD34多为弥漫强阳性 ,阳性率分别为 98 7%、6 8 4 % ,α 平滑肌肌动蛋白 (α SMA)、肌特异性肌动蛋白、S 10 0、蛋白基因产物 9 5呈片状或局灶阳性 ,阳性率分别为2 5 0 %、19 7%、2 3 7%、17 1% ,波形蛋白均阳性 ,结蛋白、胶质纤维酸性蛋白、神经丝蛋白均阴性。 76例GIST中 ,良性 9例 ,交界性Objective To study the morphologic and immunohistochemical features of gastrointestinal stromal tumors(GISTs) and to explore the reference parameters for malignancy Methods Seventy six (76) cases of primary GISTs were distinguished from a group of gastrointestinal mesenchymal tumors by use of a panel of antibodies such as CD117, CD34 by immunohistochemical EnVision method, their biologic behaviors were analyzed by including their follow up data Results All patients were adults, age range 32 to 81 years (mean 54 year), male 39 cases and female 37 cases; the tumors were situated in stomach (36 cases), in small intestine (23 cases), colon (2 cases) and rectum (15 cases) The most common symptoms were abdomen mass, vague pain and GI bleeding Forty eight (48) cases were mainly located within the muscularis propria, 25 cases outside the serosa, and 3 cases below the mucosa Grossly, they were of soft consistency often with hemorrhage, cystification or necrosis Microscopically, the tumors were composed of spindle cells (46 cases) or epithelioid cells (9 cases) and of both cells (21 cases), arranged in interlacing fasicles, diffusing sheets, pallisading, whirling, alveolar and giant pseudo rosette shapes Tumor cells often had abundant cytoplasm with light to moderate eosinophilic or slight basophilic in staining, the nuclei generally showed spindle, blunted ends, round or signet in shape with nucleoli Immunohistochemically, CD117 and CD34 showed diffuse strong expression, the positive rates were 98 7% and 68 4% respectively, α SMA, MSA, S 100, PGP9 5 showed focal expression, the positive rates were 25 0%,19 7%, 23 7% and 17 1% respectively,vimentin were all positive and desmin, GFAP, NF were all negative Nine cases were benign, 19 cases borderline and 48 cases malignant Follow up of 20 cases with benign and borderline tumors found patients alive without tumor In the malignant group of 34 cases,10 cases were alive without tumor, 10 cases developed recurrence or metastasis, and 14 case

关 键 词：胃肠肿瘤 间叶瘤 病理学 原癌基因蛋白质c-kit类 CD34抗原 间质瘤 GIST 免疫组织化学 

分 类 号：R735[医药卫生—肿瘤]