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目的观察胃肠道间质瘤（GISTs）的病理学特点并探讨其概念和诊断标准。方法在光镜观察胃肠道非上皮性梭形细胞肿瘤的基础上，运用免疫组织化学方法检测vimentin、CD34、actin和S－100。结果1988～1997年10年间共有消化道原发的非上皮性肿瘤121例，其中GISTs58例，占47．9％。GISTs由梭形细胞和上皮样细胞构成，vimentin阳性，CD34阳性，少部分病例可以表现灶性或个别细胞actin和／或S－100阳性。HE染色与平滑肌瘤、神经鞘瘤、神经纤维瘤难以鉴别，须依靠免疫组化染色。本组研究按Lewin提出的标准判断GIST的良恶性，结果为良性GIST23例，潜在恶性GIST8例，恶性GIST27例。经初步观察，此标准是可行的。结论GISTs是胃肠道的最常见非上皮性肿瘤，缺乏定向分化，根据其免疫组化特征可与平滑肌瘤、神经鞘瘤、神经纤维瘤鉴别。
Objective To observe the pathological features of gastrointestinal stromal tumors (GISTs) and discuss their concepts and diagnostic criteria. Methods Immunohistochemistry was used to detect vimentin, CD34, actin and S-100 on the basis of light microscopic observation of non-epithelial spindle cell tumors of the gastrointestinal tract. Results In the 10 years from 1988 to 1997, there were 121 cases of non-epithelial neoplasms, of which 58 cases were GISTs, accounting for 47.9%. GISTs consist of spindle cells and epithelioid cells with vimentin positive and CD34 positive. In some cases, focal or individual cells can be expressed as actin and/or S-100 positive. HE staining and leiomyoma, schwannomas, and neurofibromas are difficult to differentiate and rely on immunohistochemical staining. This group of studies evaluated the benign and malignant of GIST according to the criteria proposed by Lewin. The results were 23 cases of benign GIST, 8 cases of potentially malignant GIST, and 27 cases of malignant GIST. After preliminary observation, this standard is feasible. Conclusions GISTs are the most common non-epithelial neoplasias in the gastrointestinal tract. They lack directional differentiation and can be distinguished from leiomyomas, schwannomas, and neurofibromas based on their immunohistochemical features.