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目的探讨胃肠道间质瘤(GIST)的临床病理学特点,肿瘤风险度及预后指标。方法分析48例GIST的临床病理学特点、免疫表型和随访资料。结果48例GIST其中食管4例(8.3%),胃25例(52.1%);小肠8例(16.7%);大肠8例(16.7%),腹腔肠系膜等胃肠外3例(6.3%)。肿瘤组织形态学特点以梭形细胞和上皮样细胞为主,多呈索状和弥漫排列;48例中极低度风险性肿瘤24例(50%),低度风险性肿瘤8例(16.7%),中度风险性肿瘤11例(22.9%),高度风险性肿瘤5例(10.4%)。发生在食管和胃的GIST多为极低度和低度风险性肿瘤,小肠和大肠及肠外GIST多为中度和高度风险性肿瘤。免疫组化结果CD117阳性45例(93.8%),CD34阳性42例(87.5%),SMA阳性7例(14.6%),S-100阳性4例(8.3%),Desmin阳性5例(10.4%),vimatin全部阳性(100%)。结论GIST上皮样细胞和梭形细胞呈束状或弥漫性排列是其显著的病理组织学特征,CD117和CD34阳性表达是诊断GIST的重要依据。肿瘤的播散和转移是判断肿瘤高风险度的依据,肿瘤大小、核分裂数是判断肿瘤风险度和预后的重要参考指标。
Objective To investigate the clinicopathological features, tumor risk and prognosis of gastrointestinal stromal tumors (GIST). Methods The clinicopathological characteristics, immunophenotype and follow-up data of 48 patients with GIST were analyzed. Results 48 cases of GIST included esophagus in 4 cases (8.3%), stomach in 25 cases (52.1%), small intestine in 8 cases (16.7%), large intestine in 8 cases (16.7%) and abdominal cavity mesentery in 3 cases (6.3%). Tumor morphological features of spindle cells and epithelial cells, mostly cord-like and diffuse arrangement; 48 cases of very low risk of cancer in 24 cases (50%), low-risk tumors in 8 cases (16.7% ), Moderately risky tumors in 11 (22.9%), and high-risk tumors in 5 (10.4%). Most GISTs in the esophagus and stomach are extremely low-grade and low-risk tumors, and most of them are moderate and high-risk tumors in the small and large intestine and in the extraintestinal GIST. Immunohistochemical results showed that CD117 positive in 45 cases (93.8%), CD34 positive in 42 cases (87.5%), SMA positive in 7 cases (14.6%), S-100 positive in 4 cases , all vimatin positive (100%). Conclusion GIST epithelial-like cells and spindle-shaped cells in a bundle or diffuse arrangement is its significant histopathological features, CD117 and CD34 positive expression is an important basis for the diagnosis of GIST. Tumor spread and metastasis is to determine the high risk of tumor based on tumor size, mitotic number is to determine the risk of cancer and prognosis of an important reference index.