胃原发中度危险性胃肠道间质瘤36例临床病理观察
| 作者: |
1陈兰花,
1肖宁新,
2李荣岗
1 广东省江门市人民医院病理科，广东 江门 529030 2 广东省江门市中心医院病理科，广东 江门 529030 |
| 通讯: |
陈兰花
Email: lovexy0326@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.06.002 |
摘要
目的：探讨胃原发的中度危险性胃肠道间质瘤(gastrointestinal stromal tumors，GIST)临床病理特征，提高对改组患者的诊治水平。方法：回顾性分析36例胃原发中度危险性胃肠道间质瘤的临床病理资料。结果：36例患者年龄21~69岁，平均55岁，男女比例为0.64。临床主要表现为腹痛及黑便。发生在胃体部28例，胃底部5例，胃窦部3例，肿瘤大小平均7.5 cm (2.5~10 cm)。组织学表现为中等密集的肿瘤细胞流水样或弥漫分布，肿瘤细胞梭形或上皮样或二者混合，核分裂象平均4.8/50HPF(2~10/50HPF)，免疫组织化学染色CD117、PDGFRA、DOG-1、CD34阳性表达率分别为91.7%、88.9%、80.6%和97.2%，Ki67指数平均为6.5%(2%~8%)。随访时间8~50个月，患者1、3、5年生存率分别为97.2%、88.9%、83.3%，3例死于肿瘤复发、2例死于转移、1例死于并发症。所有患者均接受手术治疗，其中15例c-kit基因11外显子检测阳性的患者中8例术后接受伊马替尼治疗，其预后好于未接受伊马替尼治疗的患者，差异有统计学意义(P<0.05)。结论：胃原发中度危险性GIST确诊需靠病理形态学及免疫组织化学，c-kit基因检测阳性的患者手术后辅助伊马替尼治疗可明显改善患者预后。
关键词：
胃肠道间质瘤
中度危险性
临床病理特征
预后
Clinicopathological analysis of GIST of gastric primary with moderate risk
CorrespondingAuthor: CHEN Lanhua Email: lovexy0326@163.com
DOI: 10.3978/j.issn.2095-6959.2016.06.002
Abstract
Objective: To study the clinicopathological characteristics of gastrointestinal stromal tumors (GIST) of gastric primary with moderate risk and promote the diagnosis and treatment. Methods: The clinicopathological data were retrospectively analysed in 36 cases of GIST of gastric primary with moderate risk. Results: The age of 36 cases ranged from 21 to 69 years old and the mean was 55 years old. The ratio of men to women was 0.64. The major symptoms were abdominal pain and dark stools. Twenty eight of them were located at the body of stomach and 5 were located at the gastric fundus, and the remaining 3 cases were situated gastric antrum, the size ranged from 2.5~10 cm, mean 7.5 cm. Histologically, tumor cells were moderate density and a systematic distribution, or arranged lotic water. Tumor cells were spindle or mixed with epithelioid cells. The mean mitosis was 4.8/50HPF (2~10/50HPF). The positive rates of CD117, PDGFRA, DOG1 and CD34 were 91.7% (33/36), 88.9% (32/36), 80.6% (29/36) and 97.2% (35/36) in tumors. Mean index of Ki67 was 6.5% (2%~8%). Followed up for 8~50 months, the 1-, 3-, and 5-year overall survival were 97.2%, 88.9%, 83.3%, in which 3 died of the tumor recurrence, 1 died of metastasis, and 1 complication. All patients received operation, of 15 patients with c-kit positive, 8 treated with imatinib after surgery had better prognosis than those without imatinib, the difference was statistically significant (P<0.05). Conclusion: The diagnosis of GIST of gastric primary with moderate risk depends on morphology and immunohistochemistry. Adjuvant imatinib therapy after surgery can obviously improve the prognosis of patients whose gene express of c-kit are positive.