胃肠道小间质瘤的临床和病理特征分析  

Clinical and pathologic features of small gastrointestinal stromal tumor

作　　者：马娟娟[1] 谢芳[1] 唐静[1] 徐晓平[1] 何淑英[1] 白岚[1] 

机构地区：[1]南方医科大学南方医院消化内科 广东省胃肠疾病重点实验室,广州510515

出　　处：《中华消化内镜杂志》2016年第12期834-837,共4页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金（81470790）;广东省自然科学基金（S2012010009394、2015A030313295）

摘　　要：目的探讨胃肠道小间质瘤（直径〈2．0cm）的临床和病理特点。方法将2003年10月至2014年6月在南方医院行手术治疗（包括内镜手术、胸／腹腔镜手术及开放手术治疗）并经病理及免疫组化确诊为胃肠道小间质瘤的95例住院患者纳入回顾性研究，分析临床和病理资料，以及超声内镜下各危险因素与核分裂象的相关性、临床病理特征与NIH风险分级的相关性。结果95例共104处病灶，其中单发88例、多发7例；以胃部多见（81．7％，85／104），其中胃中上部占87．1％（74／85）；5例（5．3％）病理见不同程度的钙化、3例（3．2％）见局部坏死、2例（2．1％）肿瘤细胞呈现上皮样排列，NIH风险度分级极低88例（92．6％）、中度6例（6．3％）、高度1例（1．1％）；免疫组化CD34阳性率95．8％（91／95），CD117阳性率96．8％（92／95）。超声内镜下危险因素（边缘、黏膜表面、回声、异质性）与核分裂象的相关性分析未见各危险因素与核分裂象存在明显相关（P〉0．05）；临床病理特征与NIH风险分级的相关性分析仅提示病灶直径〉1．5cm与NIH风险度分级存在明显相关（P〈0．05）。结论胃肠道小间质瘤既可单发又可多发，多见于胃中上部，绝大多数呈极低或低度风险，但直径〉1．5cm时生物学行为较差，存在高风险度可能，建议干预治疗。Objective To investigate the clinical and pathologic features of small gastrointestinal stromal tumors （ small GISTs, d 〈 2. 0 cm）. Methods Medical records of 95 patients undergoing surgery （endoscopic surgery,thoracoscopic/laparoscropic surgery and open surgery）and diagnosed as having GISTs by pathology and immunohistochemistry in Nanfang hospital from October 2003 to June 2014 were retrospectively analyzed. Based on clinical and pathological results, correlation analyses between risk factors for endoscopic ultrasonography（EUS） and Mitotic count（ MI）, clinicopathologic parameter and NIH risk classification were performed. Results Among 95 cases （104 lesions）, 88 were single, while 7 were muhiple; 81.7% （85/104） small GISTs arose from stomach, including 87. 1% （74/85）in middle-upper stomach; 5 cases （5. 3% ） presented calcification of different degrees, 3 cases（3.2%） presented local necrosis and 2 cases （2. 1%） with arrangement of epithelioid cells; 88 cases （92. 6%） were very low grade of NIH risk classification, 6 cases （6. 3%） were intermediate risk and 1 case（1.1%） was high risk. Positive rates of CD34 and CD117 were 95.8%（91/95） and 96. 8%（92/95） respectively. The risk factors （border, mucosal surface, echo and heterogeneity） of EUS had no correlation with mitotic count（P〉0. 05）.The correlation analysis between clinicopathologic features and NIH risk classification revealed tumors more than 1.5 cm had a striking correlation with NIH risk classification （P〈 0. 05）. Conclusion Most small GISTs, single or multiple, located at middle-upper stomach, were of very low or low risk, and have a favorable prognosis. But it has worse biological behavior and a higher grade risk when the diameter is more than 1.5 cm, intervention should be recommended.

关 键 词：胃肠肿瘤 细胞核分裂 病理学 临床 危险性评估 

分 类 号：R735[医药卫生—肿瘤]