中老年肠道炎性肌纤维母细胞瘤临床病理及预后特点  

Clinicopathological and prognostic characteristics of intestinal inflammatory myofibroblastic tumor in middle⁃aged and elderly patients

作　　者：谭敏华[1] 陈威[1] 郭锦辉[1] 周泳健 雷伟华[1] 刘慕诗 申动[3] 申洪[4] TAN Minhua;CHEN Wei;GUO Jinhui;ZHOU Yongjian;LEI Weihua;LIU Mushi;SHEN Dong;SHEN Hong(Department of Pathology,the First People's Hospital of Zhaoqing,Zhaoqing 526060,China;不详)

机构地区：[1]肇庆市第一人民医院病理科,广东肇庆526060 [2]华南理工大学医学院,广州510000 [3]南方医科大学公共卫生学院,广州510515 [4]南方医科大学南方医院病理科/基础医学院病理学系,广州510515

出　　处：《实用医学杂志》2024年第4期503-507,共5页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:2010B060300001);肇庆市科技创新指导类项目(编号:201704031411)。

摘　　要：目的探讨中老年肠道炎性肌纤维母细胞瘤(inflammatory myofibroblastic tumours,IMT)的临床病理及预后特点。方法回顾性分析5例中老年肠道IMT的临床、病理形态、免疫表型及随访结果。结果4例IMT发生在右半结肠,1例在回肠。3/5患者有肠道损伤史,首发消化道症状且白细胞增高。瘤组织由梭形肌纤维母细胞和纤维母细胞构成,席纹状排列,浸润性生长,伴较多淋巴细胞、浆细胞浸润,可见胶原化及黏液水肿。其中一例异型性明显,核大且畸形。免疫表型:瘤细胞vimentin(5例)、SMA(5例)、desmin(3例)、ALK(3例)、CK(2例)阳性,Caldesmon、CD34、β-catenin、MC、CD117、DOG1、S-100、BCL-2、CD99、CD68均阴性,Ki-67增殖指数1.28%~10.01%。5例均完整切除肿瘤,随访53~137.5个月,其中1例83岁患者,于术后27个月影像学考虑肿瘤复发;另一例术后无瘤生存122个月,因其他原因去世;其余均无瘤生存,基本状况良好。结论(1)本组中老年肠道IMT多见于右半结肠,多有肠道损伤史,多首发消化道症状,白细胞多升高;(2)Vimentin和SMA同时阳性,多伴ALK阳性;(3)4/5的患者手术切除治疗效果好,1/5的患者术后2~3年可复发;高龄且ALK阳性、Ki67达10%、异型性明显很有可能是中老年肠道IMT复发的重要危险因素,其中ALK阳性者复发的风险或许为1/3。Objective To investigate the clinicopathological and prognostic characteristics of intestinal inflammatory myofibroblastic tumours(IMT)in middle⁃aged and elderly patients.Methods The clinical,pathologi⁃cal morphology,immunophenotype and follow⁃up results of 5 cases of intestinal IMT in middle⁃aged and elderly patients were retrospectively analyzed.Results 4 cases of IMT occurred in the right half colon and 1 in the ileum.Most patients(3/5)had a history of intestinal injury,starting the digestive tract symptoms and increased leukocytes.The tumor tissue was composed of fusiform myofibroblasts and fibroblasts arranged in storiform pattern,with an infiltrative growth pattern,accompanied by a large number of lymphocytes and plasma cells infiltration,collagen formation and myxedema.One case was atypically large and deformed.Immunophenotype:vimentin(5cases),SMA(5 cases),desmin(3 cases),ALK(3 cases),CK(2 cases)were positive.Caldesmon,CD34,β⁃catenin,MC,CD117,DOG1,S⁃100,BCL⁃2,CD99,CD68 were negative,and Ki⁃67 proliferation index was 1.28%to 10.01%.All the 5 cases underwent complete tumor resection and were followed up for 48.5 to 133 months.Among them,1 patient aged 83 was considered to have tumor recurrence 27 months after surgery.The other patient survived 122 months without tumor and died of other causes.All the others survived without tumor and were in good condition.Conclusion(1)Intestinal IMT in the middle⁃aged and elderly people in this group was more common in the right half colon,and most of them had a history of intestinal injury,first gastrointestinal symptoms and elevated white blood cells;(2)Vimentin and SMA were positive at the same time,and ALK was more positive;(3)4/5 patients had good surgical resection,and 1/5 patients could relapse 2~3 years after surgery;old age,ALK⁃positive,Ki67 up to 10%,atypia may be an important risk factor for intestinal IMT recurrence in the elderly,of which ALK⁃positive patients may have a recurrence risk of 1/3.

关 键 词：肠道肿瘤 炎性肌纤维母细胞瘤 临床 病理 中老年 

分 类 号：R735.3[医药卫生—肿瘤]