48例胃肠间质瘤的临床病理特点及诊断陷阱分析  

Analysis of Clinicopathological Features and Diagnostic Trap of 48 Cases of Gastrointestinal Stromal Tumor

作　　者：黄萱[1] 李艳[1] 陈琼霞[1] 陈莹[1] 镇鸿燕[1] HUANG Xuan;LI Yan;CHEN Qiongxia;CHEN Ying;ZHEN Hongyan(Department of Pathology and Pathophysiology,School of Medicine,Jianghan University,Wuhan 430056,Hubei,China)

机构地区：[1]江汉大学医学院病理学与病理生理学教研室,湖北武汉430056

出　　处：《江汉大学学报（自然科学版）》2022年第1期72-78,共7页Journal of Jianghan University：Natural Science Edition

摘　　要：目的探讨胃肠间质瘤的临床病理特点及鉴别诊断。方法对48例胃肠间质瘤病例行常规HE和免疫组织化学染色检查,并随访;同时结合相关文献复习对其临床病理特点进行分析。结果该类病变形态学表现多样,平滑肌样肿瘤细胞形态一致,较温和,呈编织状、束状排列;肿瘤细胞也可呈上皮样外观,部分瘤细胞呈假菊形团样结构及栅栏状结构,细胞增生活跃,可见多核瘤巨细胞及黏液样基质。肿瘤细胞在Vimentin、CD117、Dog-1、CD34均表达阳性;S-100和SMA在部分病例中表达阳性;Ki-67增值指数随着肿瘤级别增高,呈2%~25%;p53在中、高级别的病变中呈阳性表达;ER-α36在瘤细胞呈强阳性表达,定位在胞膜/浆。全组病例建立随访,其中10例失访,11例死亡。结论胃肠间质瘤是一种不同恶性潜能的间质肿瘤。组织形态学特点是重要的诊断依据,免疫指标CD117和Dog-1的联合检测可辅助其诊断及鉴别诊断,雌激素受体-α的新亚型ER-α36在胃肠间质瘤中呈高表达,为该类疾病的发病机制及治疗提供了新的研究方向。Objective To investigate the clinicopathological features and differential diagnosis of gastrointestinal stromal tumor(GIST).Methods 48 cases of GIST were examined by routine HE and immunohistochemical staining and followed up.At the same time,we analyzed the clinicopathological characteristics combined with relevant literature reviews.Results Morphological manifestations of these lesions were diverse.Smooth muscle tumor cells were uniform,mild,braided,and bundled;tumor cells could also have an epithelioid appearance;some tumor cells had a pseudochrysanthemum-shaped mass structure and palisade structure.There was active cell proliferation,including giant multinucleolate and myxoid stroma cells.Vimentin,CD117,Dog-1,and CD34 were all positive in tumor cells.S-100 and SMA were positive in some cases.The Ki-67 increment index increased with tumor grade,which was 2%~25%.p53 was positively expressed in the middle and high levels of lesions.The expression of ERα36 was strongly positive in tumor cells and localized in the cell membrane/plasma.Follow-up was established in the whole group,10 cases were lost to follow-up,and 11 patients died.Conclusion The GIST is a kind of stromal tumor with different malignant potential.The combined detection of CD117 and Dog-1 can assist the diagnosis and differential diagnosis of GIST.The expression of ERα36,a new subtype of estrogen receptor-αis highly expressed in GIST,which provides a new research direction for the pathogenesis and treatment of this disease.

关 键 词：胃肠间质瘤 免疫组织化学 鉴别诊断 

分 类 号：R735.02[医药卫生—肿瘤]