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目的探讨胃肠道间质瘤(Gastricintestinaltumour,GIST)的生物学性质与临床病理特点的关系,为临床判断GIST的良、恶性提供参考。方法回顾性分析本院2000年6月～2005年6月经手术和病理证实的38例GISTs病例的资料。本组男性20例,女性18例,年龄(18～73岁),平均55.2岁,38例GIST病人均行手术治疗,术后对38例切除标本进行横径检测;光镜下观察38例肿瘤细胞形态;对肿瘤细胞进行免疫组化检测。结果38例病人基本能完整切除肿瘤,26例良性GISTs中,肿物平均直径3.16cm,5例潜在恶性GISTs中,平均直径5.25cm,7例恶性肿瘤中,平均直径9.17cm。光镜下细胞形态分类:梭形细胞为主型21例,上皮细胞为主型12例,混合细胞型5例。良性组肿瘤无明显出血、坏死,细胞无异型性,核分裂少见。恶性组肿瘤组可见出血坏死,细胞丰富,明显异型性,核分裂多见。38例行以下五个免疫组化指标测定:其中酪氨酸激酶受体(CD117)阳性者32例,骨髓干细胞抗原(CD34)阳性者31例,波形蛋白(Vimentin)阳性者28例,可溶性酸性蛋白(S-100)阳性者15例,平滑肌肌动蛋白(SMA)阳性者10例。结论GIST主要发生在胃和小肠,发病部位跟性别、年龄无关。CD117和CD34阳性标记是确诊GIST最有价值的免疫标记物。GIST的恶性程度与肿瘤是否出血坏死、大小、核分裂数密切相关,而与发生部位、性别、年龄、免疫表型无关,免疫表型与肿瘤部位也无关。
Objective To investigate the relationship between the biological characteristics of gastrointestinal stromal tumor (GIST) and the clinicopathological features of GIST, and to provide a reference for judging the malignant and benign of GIST clinically. Methods A retrospective analysis of our hospital from June 2000 to June 2005 confirmed by surgery and pathology in 38 cases of GISTs data. The group of 20 males and 18 females, aged (18-73 years) with an average of 55.2 years of age, 38 cases of GIST patients underwent surgical treatment of 38 cases of resected specimens after the diameter of detection; microscopic observation of 38 cases of tumors Cell morphology; Immunohistochemical detection of tumor cells. Results Thirty-eight patients underwent complete resection of the tumor. The average diameter of tumor was 3.16 cm in 26 cases of benign GISTs and 5.25 cm in 5 cases of potentially malignant GISTs. The average diameter was 9.17 cm in 7 cases of malignant tumors. According to the morphology of the cells under light microscope, 21 were spindle-type, 12 were epithelial-type and 5 were mixed-cell type. Benign tumors without hemorrhage, necrosis, cell atypia, rare mitotic. Malignant tumor group showed hemorrhage and necrosis, rich cells, obvious atypia, more common nuclear fission. Thirty-eight cases had the following five immunohistochemical parameters: 32 cases were positive for tyrosine kinase receptor (CD117), 31 cases were positive for bone marrow stem cell antigen (CD34), 28 cases were positive for Vimentin, soluble acidic Fifteen cases were positive for protein S-100 and ten were positive for smooth muscle actin (SMA). Conclusions GIST mainly occurs in the stomach and small intestine. The incidence of GIST is not related to sex and age. CD117 and CD34 positive markers are the most valuable immune markers for the diagnosis of GIST. The degree of malignancy of GIST is closely related to whether hemorrhage, necrosis, size and mitosis are related to the tumor, but not to the occurrence site, sex, age, and immunophenotype.