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目的探讨胃肠道间质瘤(G IST)的病理学特征及鉴别诊断。方法常规HE染色及免疫组织化学(S-P法)染色观察51例原发性胃肠道间质瘤的病理组织学形态及抗体CD117、CD34、V im entin、S-100、Syn、NSE、SMA、ACT免疫组织化学表达特点,并对其形态学特征及生物学行为进行分析。结果本组51例G IST中,梭形细胞型27例,上皮样细胞型9例,混合型15例。良性14例,交界性10例,恶性27例。瘤细胞CD117、CD34和V im entin多为弥漫性强阳性,阳性率分别为100.0%、72.5%和100.0%;部分病例SMA、ACT、S-100、SY-N、NSE呈局灶性阳性。结论本组病例组织形态变化多样,有些特征容易误诊为其他肿瘤。免疫组化CD117(c-k it蛋白)和CD34阳性表达是确诊G IST最有诊断价值的依据。诊断时主要是同消化道的其他梭形细胞肿瘤进行鉴别。依据肿瘤生长的大小、细胞核异形性及核分裂相活性来判断肿瘤的恶性程度,恶性度高的肿瘤往往伴有明显的出血及坏死。
Objective To investigate the pathological features and differential diagnosis of gastrointestinal stromal tumor (G IST). Methods The histopathological features of 51 cases of primary gastrointestinal stromal tumors were observed by HE staining and immunohistochemistry (SP) staining. The antibodies CD117, CD34, V im entin, S-100, Syn, NSE, SMA, ACT immunohistochemical expression characteristics, and its morphological characteristics and biological behavior were analyzed. Results In this group of 51 cases of GIST, spindle cell type was 27 cases, epithelioid cell type was 9 cases, mixed type was 15 cases. There were 14 cases of benign, 10 cases of borderline, and 27 cases of malignancy. The tumor cells CD117, CD34, and V im entin were mostly diffuse positive, with positive rates of 100.0%, 72.5%, and 100.0%, respectively. In some cases, SMA, ACT, S-100, SY-N, and NSE were focally positive. Conclusion The morphological changes of this group of patients are various, and some features are easily misdiagnosed as other tumors. Immunohistochemical CD117 (c-k it protein) and CD34 positive expression is the most diagnostic basis for the diagnosis of GIST. Diagnosis is mainly to identify other spindle cell tumors of the digestive tract. The degree of malignancy of the tumor was judged based on the size of the tumor growth, nuclear atypia, and mitotic activity. Highly malignant tumors were often accompanied by significant hemorrhage and necrosis.