60例胃肠道间质瘤临床病理及免疫组化特征

目的：探讨胃肠道问质瘤（gastrointestinal stromal tumors，GIST）的临床病理特点、免疫组化特性及其诊断标准和免疫组化在诊断中的价值．方法：复习60例胃肠道间质瘤病例，分析其临床病理学特点，并进行免疫组织化学染色研究．结果：60例中20例发生在胃，14例发生在小肠，12例发生在结肠，9例发生在肠系膜，5例发生在食管．光镜下有梭形细胞和上皮细胞两种形态．肿瘤分为四个亚型：平滑肌细胞分化型（16例），神经源性分化型（9例），平滑肌和神经双向分化型（12例），未分化型（23例）．免疫组化染色：肿瘤细胞CD34阳性40例，CD117阳性60例，部分病例Aetin、SMA和／或S-100、PGP9．5阳性．肿瘤有良性、交界性和恶性三种分化．结论：GIST是发生在消化道的-组间叶源性肿瘤，免疫组化特征为CD17阳性率100％，CD34阳性率66，7％。光镜下细胞形态相似，不易分型，需做免疫组化分型，并根据肿瘤大小、细胞分化程度、免疫组化分型等综合分析确定生物学行为．

Clinicopathologic and Immunohistochemical Features of 60 Cases of Gastrointestinal Stromal Tumors

Objective:To investigate the clinicopathologic features,immunohistochemical characteristics , diagnostic criteria and the value of the immunohistochemical staining in the diagnosis of the gastrointestinal stromal tumor ( GIST). Methods: 60 cases of gastrointestinal stromal tumors were reviewed. The clinical and pathological records as well as all the available cytological studies were performed on formalin - fixed, paraffin - embedded tissue blocks of the gastrointestinal stromal tumors. Results:20 cases originated in stomach, 14 cases in small intestine, 12 cases in large intestine, 9 cases in mesentery,5 cases in esophagus. The tumors showed two basic cell components with spindle cells and epithelial cells. The neoplasms were classified as follows: liomyoma (16 cases) ,neurogenic tumor (9 cases) , mixed cell type (12 cases) and undifferentiated type (23 cases). Immunoreactivity for CD34 were positive in 40 cases ,60 cases of the tumors were positive for CD117, while a few cases showed weak positivity for Actin,SMA and/or S- 100 protein and PGP9. 5. The tumor had three classifications: benign, borderline and malignant. Conclusion: GIST is the most common mesenchymal tumor. Its different classifications are similar in light microscopic appearance. It is essential to depend on immunohistochemical features,size and cell differentiation to analyze comprehensively its biological behavior.