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目的:探讨胃肠间质瘤(GIST)的诊断标准、良恶性参考指标和预后因素。方法:分析GIST的临床表现、病理组织形态,用免疫组织化学Envision法检测其CD117、CD34、a-SMA、S-100蛋白的表达状况,并结合随访资料,分析其生物学行为。结果:本组GIST平均年龄57.5岁。最常见症状为腹痛和消化道出血。肿瘤境界清楚,切面灰白,部分区可见出血、坏死、囊性变等继发性改变。镜下:梭形细胞型48例,上皮样细胞型5例,梭形/上皮样细胞混合型3例。CD117和CD34多弥漫强阳性,阳性率为89.29%、80.36%。a-SMA、S-100阳性率分别为28.57%、25%。56例GIST中,良性9例,交界性15例,恶性32例。良性与交界性病例随访24例均健在;恶性病例随访24例,18例无瘤生存,6例复发与转移。结论:GIST好发于中老年,瘤细胞形态多变,排列结构多样。免疫组织化学特征CD117、CD34阳性。肿瘤临床和病理形态、CD117和CD34表达是诊断GIST的要点。肿瘤直径>5cm,核分裂相>5/50HPF可作为良恶性参考指标。肿瘤性坏死、核分裂相>5/50HPF及肿瘤大小是预后的重要因素。
Objective: To investigate the diagnostic criteria, benign and malignant reference indexes and prognostic factors of gastrointestinal stromal tumors (GIST). Methods: The clinical manifestations and histopathological changes of GIST were analyzed. The expression of CD117, CD34, a-SMA and S-100 protein was detected by immunohistochemistry. The biological behavior of GIST was analyzed with follow-up data. Results: The average age of GIST in this group was 57.5 years. The most common symptoms are abdominal pain and gastrointestinal bleeding. Clear tumor realm, gray section, visible bleeding, necrosis, cystic degeneration and other secondary changes. Microscope: spindle cell type in 48 cases, epithelioid cell type in 5 cases, spindle / epithelial cell mixed type in 3 cases. CD117 and CD34 more diffuse positive, the positive rate was 89.29%, 80.36%. The positive rates of a-SMA and S-100 were 28.57% and 25% respectively. 56 cases of GIST, benign in 9 cases, borderline in 15 cases, 32 cases of malignant. 24 cases were followed up in benign and borderline cases; 24 cases were followed up in malignant cases, 18 cases survived without recurrence and 6 cases had recurrence and metastasis. Conclusion: GIST mainly occurs in middle-aged and elderly patients. The morphology of tumor cells is variable and its arrangement is diverse. Immunohistochemical features CD117, CD34 positive. Clinical and pathological features of the tumor, CD117 and CD34 expression are the main points in the diagnosis of GIST. Tumor diameter> 5cm, mitotic phase> 5 / 50HPF can be used as benign and malignant reference index. Tumor necrosis, mitotic phase> 5 / 50HPF and tumor size are important prognostic factors.