胃炎性肌纤维母细胞瘤临床病理分析
| 作者: |
1方三高,
1马强,
1马瑜,
1曾英,
1李艳青,
1肖华亮
1 第三军医大学大坪医院野战外科研究所病理科，重庆 400042 |
| 通讯: |
方三高
Email: angsangaode@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2013.03.006 |
摘要
目的:探讨胃炎性肌纤维母细胞瘤 (gastric inflammatory myofibroblastic tumor，GIMT)的临床病理特征、诊断与鉴别诊断。方法: 对2例GIMT进行临床病理分析及免疫组织化学研究，并复习相关文献。结果:例1患者为女性，72岁，临床表现为上腹不适，胃镜见靠近胃体前壁息肉状肿块突向胃腔，行胃次全切除术及毕罗I式重建。例2，男性，43岁，主诉左上腹痛，CT扫描显示胃–食管交界区黏膜下广基或透壁性新生物。两例患者临床分别诊断为胃肠间质瘤及胃癌，而术后病理却证实为GIMT。大体所见：灰白色结节状肿物边界不清，质地不均，表面被覆完整黏膜。镜下显示肿瘤由密集的梭形细胞和大量的慢性炎细胞组成。这些梭形细胞呈束状或席纹状排列，胞质空泛或淡嗜酸性，核呈卵圆形，具有模糊的核仁，核分裂象难以见到；而浸润于黏液样基质中的炎性细胞主要由淋巴细胞、浆细胞组成，部分区域形成淋巴滤泡，类似于炎性或反应性病变。免疫组织化学显示肿瘤细胞弥漫表达vimentin和h-caldesmon，部分表达间变性淋巴瘤激酶 (anaplastic lymphoma kinease，ALK)，不表达CD34，CD117及desmin。两例经随访4～6个月均未见肿瘤复发及转移。结论: GIMT是一种罕见的具有独特病理改变的纤维性病变，易与胃肠间质瘤、平滑肌瘤等混淆。
关键词：
胃肿瘤；胃炎性肌纤维母细胞瘤；临床病理；鉴别诊断
Clinicopathological analysis of gastric inflammatory myofibroblastic tumor
CorrespondingAuthor: FANG Sangao Email: angsangaode@163.com
DOI: 10.3978/j.issn.2095-6959.2013.03.006
Abstract
Objective: To investigate the clinicopathologic features, diagnosis and differential diagnosis of gastric inflammatory myofibroblastic tumor (GIMT). Methods: Two cases of GIMT were studied by clinicopathologic analysis and immunohistochemistry, and the related literature was reviewed. Results: In Case one, a
72-year-old female presented with vague abdominal discomfort. She was underwent a subtotal gastrectomy and Billroth I reconstruction after endoscopy, displaying a polypoid mass toward cardial lumen near the posterior wall stomach body. In Case two, a 43-year-old male presented a complaint of left upper quadrant pain. CT scan revealed a broad-based submucosal or intramural neoplasm located in the gastro-oesophageal junction. A gastrointestinal stromal tumor and a leiomyoma were diagnosed by clinical examination in case 1 and case 2, respectively. They were, however, identified unexpectedly as GIMT by post-operative pathologic findings. Grossly, the GIMTs showed as ill-defined, solitary grey-white nodules vary from slightly firm to soft. Microscopically, the neoplasm was composed of compact spindle cells and chronic inflammatory cells. The spindle cells were in a interlacing fascicular or storiform pattern, displaying oval nuclei with inconspicuous nucleolus or lightly eosinophilic cytoplasm. Whereas mitosis was difficult to be seen. The inflammatory cells in matrix are lymphocytes and plasmacytes, similar to an inflammatory or reactive lesion. Immunohistochemically, the spindle-shaped cells were positive for vimentin, h-caldesmon, and partly positive for anaplastic lymphoma kinease (ALK), but negative for CD34, CD117, and desmin. No recurrence or metastasis was found in both cases after a follow-up for 4–6 months. Conclusion: GIMT is a rare interstitial tumor of the stomach. It should be distinguished from other diseases such as gastrointestinal stromal tumor, leiomyoma, inflammatory fibroid polyp, and so on.
72-year-old female presented with vague abdominal discomfort. She was underwent a subtotal gastrectomy and Billroth I reconstruction after endoscopy, displaying a polypoid mass toward cardial lumen near the posterior wall stomach body. In Case two, a 43-year-old male presented a complaint of left upper quadrant pain. CT scan revealed a broad-based submucosal or intramural neoplasm located in the gastro-oesophageal junction. A gastrointestinal stromal tumor and a leiomyoma were diagnosed by clinical examination in case 1 and case 2, respectively. They were, however, identified unexpectedly as GIMT by post-operative pathologic findings. Grossly, the GIMTs showed as ill-defined, solitary grey-white nodules vary from slightly firm to soft. Microscopically, the neoplasm was composed of compact spindle cells and chronic inflammatory cells. The spindle cells were in a interlacing fascicular or storiform pattern, displaying oval nuclei with inconspicuous nucleolus or lightly eosinophilic cytoplasm. Whereas mitosis was difficult to be seen. The inflammatory cells in matrix are lymphocytes and plasmacytes, similar to an inflammatory or reactive lesion. Immunohistochemically, the spindle-shaped cells were positive for vimentin, h-caldesmon, and partly positive for anaplastic lymphoma kinease (ALK), but negative for CD34, CD117, and desmin. No recurrence or metastasis was found in both cases after a follow-up for 4–6 months. Conclusion: GIMT is a rare interstitial tumor of the stomach. It should be distinguished from other diseases such as gastrointestinal stromal tumor, leiomyoma, inflammatory fibroid polyp, and so on.