论文部分内容阅读
目的 研究胃肠道间质瘤 (GISTs)的光镜、电镜形态特点和免疫组织化学在诊断中的价值 ,探讨肿瘤的组织来源和分型。方法 对GISTs进行光镜和超微结构的观察 ,用EnVision二步法免疫组织化学方法检测波形蛋白、CD117(c kit)、CD34等 8种抗原标记物在肿瘤中的表达情况。结果 6 5例GISTs占同期消化系统间叶性肿瘤的 85 5 % (6 5 / 76 ) ;其中梭形细胞为主的有 4 6例 ,伴有上皮样细胞的有 13例 ,单纯由上皮样细胞组成的有 6例 ,瘤细胞呈长、短梭形和圆形 ,胞质弱嗜酸 ,常见核端空泡 ,有时呈印戒样或透明细胞样 ;排列呈旋涡状、栅栏状或弥漫性巢状。超微结构表现出树枝样突起、神经内分泌颗粒、桥粒样连接等神经分化特点 ,或 (和 )胞质内出现密斑、密体等肌性分化。免疫组织化学显示肿瘤组织中抗原标记物表达阳性率波形蛋白为 10 0 % (6 5 / 6 5 ) ,CD11793 8% (6 1/ 6 5 ) ,CD3478 5 % (5 1/ 6 5 )。结论 GISTs是消化道最常见的间叶性肿瘤 ,光镜形态与真性肌源性和神经源性肿瘤极为相似 ,电镜和CD117、CD34等免疫标记物配合使用可对其做作出正确诊断 ,GISTs可能起源于多潜能的、卡哈尔间质细胞样的前体细胞
Objective To investigate the value of light microscopy, electron microscopy and immunohistochemistry in the diagnosis of gastrointestinal stromal tumors (GISTs) and to investigate the origin and classification of the tumors. Methods The light microscopy and ultrastructure of GISTs were observed. EnVision two-step immunohistochemical method was used to detect the expression of 8 antigen markers including vimentin, CD117 (c kit) and CD34 in the tumor. Results Sixty-five GISTs accounted for 85 5% (65/76) of the digestive system mesenchymal tumors in the same period. Among them, 46 cases were mainly spindle cells and 13 cases were epithelial-like cells, Cells composed of 6 cases, tumor cells were long, short spindle and round, weak cytoplasm acidophilic, common nuclear vacuoles, sometimes showed ring-like or clear cell-like; arranged in a spiral, palisading or diffuse Sexual nests. The ultrastructure showed the features of dendrites, neuroendocrine granules, desmosome-like connections and other features of neural differentiation, and (or) the cytoplasm appeared dense spots, dense body and other muscle differentiation. Immunohistochemistry showed that the positive rate of antigen marker expression in tumor tissue was 10 0% (6 5/65), 8% (11/6 5) for CD11793, and 5% (5 1/6 5%) for CD3478. Conclusions GISTs are the most common melanocytoma in the digestive tract. The morphology of the light microscope is very similar to those of myogenic and neurogenic tumors. Electron microscopy and immunological markers such as CD117 and CD34 may be used to make correct diagnosis. GISTs may Originated from pluripotent, Cajal stromal cell-like precursor cells