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目的探讨胃肠道间质瘤(GIST)的临床病理特征及诊断治疗方法。方法回顾性分析218例已行手术治疗的GIST患者的临床资料。通过光镜观察形态特征,应用免疫组织化学(SP法)检测CD117,CD34,S-100,波形蛋白(vimentin,VIM)和平滑肌肌动蛋白(SMA)的表达情况。结果218例中,胃间质瘤152例(69.7%),小肠间质瘤27例(12.4%),结直肠间质瘤30例(13.8%),食管间质瘤9例(4.1%);其中恶性116例(53.2%)。临床表现缺乏特异性,常以腹部肿物和消化道出血为首发症状。通过手术标本病理组织学和免疫组化检测均明确诊断。染色显示肿瘤组织中抗原表达:CD117呈弥漫强阳性,CD34和VIM多呈弥漫强阳性,SMA和S-100偶尔呈局灶或散在阳性,阳性率分别为100%,76.2%,38.1%,4.8%和4.8%,其阳性表达率与肿瘤良、恶性无关(P>0.05)。58例随访6个月至3年,19例(均为恶性)发生复发和转移,因复发再次手术者5例。结论CD117是诊断GIST的敏感而特异的标记物,但免疫表型与肿瘤良、恶性无关。手术整块切除是治愈GIST的惟一首选方法。
Objective To investigate the clinicopathological features and diagnosis and treatment of gastrointestinal stromal tumors (GIST). Methods The clinical data of 218 patients with GIST who underwent surgical treatment were retrospectively analyzed. Morphological characteristics were observed by light microscopy. The expression of CD117, CD34, S-100, vimentin (VIM) and smooth muscle actin (SMA) were detected by immunohistochemistry (SP method). Results Among the 218 patients, 152 (69.7%) had gastric stromal tumors, 27 (12.4%) had small intestinal stromal tumors, 30 (13.8%) had colorectal stromal tumors and 9 (4.1%) had esophageal stromal tumors. Among them, 116 cases were malignant (53.2%). Lack of specificity of clinical manifestations, often with abdominal mass and gastrointestinal bleeding as the first symptom. Through the surgical specimens of histopathology and immunohistochemistry are clear diagnosis. Staining showed antigen expression in tumor tissue: CD117 was diffusely positive, CD34 and VIM mostly diffusely strong positive, SMA and S-100 occasionally focal or scattered positive, the positive rates were 100%, 76.2%, 38.1%, 4.8 % And 4.8% respectively. The positive expression rate was not related to benign and malignant tumors (P> 0.05). 58 cases were followed up for 6 months to 3 years, 19 cases (both were malignant) recurrence and metastasis, recurrence due to recurrence in 5 cases. Conclusion CD117 is a sensitive and specific marker for the diagnosis of GIST. However, immunophenotype has no relation with benign and malignant tumors. Surgical lump removal is the only method of choice for curing GIST.