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目的 探讨胃肠道间质瘤 (GIST)的临床表现、免疫组织化学特点及预后因子。方法 1998～ 2 0 0 3年同济大学附属东方医院用病理、免疫组化确诊 2 5例GIST ,结合临床资料 ,对其生物学行为进行分析。结果 发生于食管 1例 ,胃 11例 ,十二指肠 4例 ,空肠 8例 ,直肠 1例。镜下观察 ,梭形细胞 2 3例 ,上皮样细胞 2例。免疫组化CD117、CD34、Vim、SMA、S - 10 0和Des的阳性率分别为 88%、80 %、88%、2 0 %、2 0 %和 0 %。根据肿瘤大小及核分裂象将 2 5例病人分为良性组 2例、低度危险组 11例、中度危险组 5例及高度危险组 7例。随访显示低度、中度、高度危险组中出现囊性变的比率分别为 0、6 0 %、10 0 %。 3组中的病死率分别为 0、2 0 .0 %、4 2 . 9%。结论 GIST好发于中老年 ,男女发生率相等。肿瘤细胞形态多为梭形 ,免疫组织化学为CD117、CD34、Vim阳性。直径大于 5cm、核分裂象大于 5 / 5 0HPF(高倍显微镜 )及囊性变可作为GIST预后差的预测因子。
Objective To investigate the clinical manifestations, immunohistochemistry and prognostic factors of gastrointestinal stromal tumors (GIST). Methods Twenty-five cases of GIST were confirmed by pathology and immunohistochemistry at Dongfang Hospital, Tongji University from 1998 to 2003, and their biological behaviors were analyzed with clinical data. The results occurred in 1 case of esophagus, stomach 11 cases, duodenal in 4 cases, jejunum in 8 cases, rectum in 1 case. Microscopically, there were 23 spindle cells and 2 epithelial cells. The positive rates of immunohistochemistry for CD117, CD34, Vim, SMA, S - 100 and Des were 88%, 80%, 88%, 20%, 20% and 0%, respectively. According to tumor size and mitosis, 25 patients were divided into 2 cases of benign group, 11 cases of low risk group, 5 cases of moderate risk group and 7 cases of high risk group. Follow-up showed that the rates of cystic degeneration in the patients with low, moderate and high risk groups were 0, 60% and 100% respectively. The mortality rates in the three groups were 0, 2.0% and 42.9%, respectively. Conclusion GIST occurs in middle-aged and elderly people, the incidence of men and women are equal. Tumor cells mostly spindle shape, immunohistochemistry CD117, CD34, Vim positive. Diameter greater than 5cm, mitotic figures greater than 5 / 50HPF (high power microscope) and cystic degeneration can be used as predictors of poor prognosis of GIST.