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目的:总结胃肠道间质瘤(GIST)的病理学分析和临床诊疗经验。方法:通过免疫组织化学Envision法确诊87例GIST并分析其病理特征、免疫表型、临床表现及影像学检查。结果:位于胃者59例(67.8%),小肠23例(26.4%),结肠1例(1.1%),其他部位(系膜、网膜及后腹膜)4例(4.6%)。87例GIST的免疫组化染色显示,波形蛋白阳性者为87例(100%),CD117 87例(100%),CD34 75例(86.2%),SMA 11例(12.6%),结蛋白8例(9.2%),S-10017例(19.5%),NSE 13例(14.9%)。诊断为良性GIST者11例(12.6%),潜在恶性18例(20.7%),低度恶性28例(32.2%),高度恶性30例(34.5%)。总的随访率为76/87(87.4%)。通过病史及随访发现复发或转移的病例共12例(13.8%)。所有病例均接受了手术治疗,其中3例有术后复发/转移的病人接受了格列卫治疗。结论:GIST的确诊主要依靠病理学观察及免疫组化检测,CD117是诊断GIST的重要标记物。肿瘤大小和细胞核分裂数是判断良、恶性GIST的重要指标。手术完整切除肿瘤是治疗GIST的关键;甲磺酸伊马替尼对治疗无法切除或者复发/转移的恶性GIST能取得一定的疗效。对GIST病人术后的长期随访是必要的。
Objective: To summarize the pathological analysis and clinical experience of gastrointestinal stromal tumors (GIST). Methods: 87 cases of GIST were diagnosed by immunohistochemical Envision method and their pathological features, immunophenotype, clinical manifestations and imaging examination were analyzed. Results: In the stomach, 59 (67.8%) were in the stomach, 23 (26.4%) were in the small intestine, 1 (1.1%) in the colon, and 4 (4.6%) were in other sites (mesangial, omental and retroperitoneal). Immunohistochemical staining of 87 cases of GIST showed that 87 cases (100%) were positive for vimentin, 87 cases (100%) were CD117, 75 cases (86.2%) were CD34, 11 cases (12.6%) were SMA, (9.2%), S-10017 cases (19.5%) and NSE 13 cases (14.9%). Eleven patients (12.6%) were diagnosed as benign GIST, 18 (20.7%) were potential malignant, 28 (32.2%) were low malignant and 30 (34.5%) were malignant. The overall follow-up rate was 76/87 (87.4%). A total of 12 cases (13.8%) of recurrent or metastatic cases were found by medical history and follow-up. All cases were treated surgically, and 3 of the patients with postoperative recurrence / metastasis received Gleevec treatment. Conclusion: The diagnosis of GIST mainly depends on pathological observation and immunohistochemistry. CD117 is an important marker for the diagnosis of GIST. Tumor size and mitotic numbers are important indicators for the diagnosis of benign and malignant GIST. Surgical complete resection of the tumor is the key to the treatment of GIST; imatinib mesylate for the treatment of unresectable or recurrent / metastatic malignant GIST can achieve some effect. Long-term follow-up of GIST patients after surgery is necessary.