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目的探讨上消化道胃肠道间质瘤(GIST)的内镜、病理及免疫组化特征。方法选取广东省南雄市人民医院2014年3月至2017年4月收治的96例上消化道GIST患者作为研究对象,分析其内镜、病理及免疫组化特征。结果内镜检出率92.7%(89/96),胃镜下黏膜光整占39.6%(38/96),黏膜糜烂或溃疡占53.1%(51/96);96例GIST患者瘤体直径为1.5~20.0 cm,主要由梭形细胞或上皮样细胞或两种细胞混合组成肿瘤细胞;GIST发生于胃部67例(70.0%)、小肠16例(16.6%)、食管6例(6.2%)、胃肠外7例(7.2%);胃和食管间质瘤为极低度、低度、中度及高度风险性肿瘤的概率相同,小肠间质瘤多为中度风险性肿瘤和高度风险性肿瘤,消化道外间质瘤多为高度风险性肿瘤;96例GIST患者中CD117阳性86例(89.6%)、CD34阳性64例(66.7%)、SMA阳性16例(16.7%)、S-100阳性8例(8.3%),故GIST以CD117、CD34为高表达,SMA、S-100为低表达。结论上消化道GIST内镜下表现多样,瘤变主要发生于胃部,CD117、CD34等指标具有较高诊断价值,临床诊断还需结合肿瘤风险性、组织学特征等因素。
Objective To investigate the endoscopic, pathological and immunohistochemical features of gastrointestinal stromal tumors (GISTs) in upper gastrointestinal tract. Methods Ninety-six patients with upper gastrointestinal GIST admitted from Nanxiong People's Hospital of Guangdong Province from March 2014 to April 2017 were selected as the research object, and their endoscopic, pathological and immunohistochemical characteristics were analyzed. Results The rate of endoscopy was 92.7% (89/96), mucosal lumpectomy was 39.6% (38/96), mucosal erosion or ulcer was 53.1% (51/96), and the diameter of tumor in 96 patients with GIST was 1.5 ~ 20.0 cm, mainly composed of spindle cells or epithelioid cells or a combination of two kinds of cells. GIST occurred in 67 cases (70.0%) in the stomach, 16 cases (16.6%) in the small intestine and 6 cases (6.2%) in the esophagus. 7 cases (7.2%) were extraparenterally. The probability of gastric and esophageal stromal tumors were the same as that of the lowest, the lowest, the moderate and the high risk, and the most of the small intestine stromal tumors were moderately risky tumors and high risk Most of the 96 GIST patients were CD117 positive (89.6%), CD34 positive 64 (66.7%), SMA positive 16 (16.7%), S-100 positive 8 cases (8.3%), so GIST to CD117, CD34 high expression, SMA, S-100 low expression. Conclusions There are many endoscopic manifestations of GIST in upper gastrointestinal tract. The tumor mainly occurs in the stomach. The indexes of CD117 and CD34 are of high diagnostic value. The clinical diagnosis should be combined with the risk of tumor and histological features.