小肠原发胃肠间质瘤13例临床病理分析.docVIP

小肠原发胃肠间质瘤13例临床病理分析 　　[摘要] 目的 探讨小肠原发胃肠间质瘤的临床病理学特征、免疫组化特点及鉴别诊断要点。 方法 对13例小肠原发胃肠间质瘤的病理形态和免疫组化特点观察，并进行文献复习和讨论。 结果 13例病例中男8例，女5例，年龄34～76岁，平均52岁。8例位于空肠，3例位于回肠，2例位于十二指肠。低危险度1例，中危险度4例，高危险度8例。肿瘤直径1.6～18 cm。13例中，梭形细胞型6例，上皮细胞型3例，混合细胞型4例。免疫组化13例CD117、DOG-1、Vimentin均阳性，13例Desmin、S-100均阴性。仅5例CD34阳性，5例SMA阳性，10例Nestin阳性，Ki-67阳性（+8%～+30%）。 结论 小肠间质瘤是较少见的消化道肿瘤，预后显著差于胃GIST。手术是有效的治疗方法。 　　[关键词] 小肠；胃肠间质瘤；临床病理；免疫组化 　　[中图分类号] R735.3 [文献标识码] B [文章编号] 1673-9701（2015）16-0109-02 　　[Abstract] Objective To investigate the clinical and pathological features，immune phenotype，diagnosis，differential diagnosis of small intestine gastrointestinal stromaI tumors（GIST）. Methods Clinical manifestations， pathological features and immunohistochemical characteristics were analyzed in 13 cases of small intestine gastrointestinal stromal tumors with review of the relative literature. Results Of 13 cases，age ranged from 34 to 76 years （mean 52 years），including 8 males and 5 females. There were 8 cases in jejunum，3 cases in ileum，2 cases in duodenum. In 13 patients，1 case was low risk，4 cases were middle risk，and 8 cases were high risk The diameter of tumors was 1.6-18 cm. Of 13 cases，there were 6 cases of spindle cell type，3 cases of epithelioid cell type and 4 cases of mixed cell type. Immunohistochemically，tumor cells were positive for CD117，DOG-1，Vimentin，but negative for Desmin， S-100. CD34 and SMA were positive in 5 cases，nestin was positive in 10 cases. The positive rate of Ki-67 was from +8% to +30%. Conclusion Small intestinal stromal tumors are rare tumors of alimentary tract， the prognosis was significantly worse in gastric GIST. Surgery is the principal and effective procedure for the tumors. 　　[Key words] Small intestine；Gastrointestinal stromal tumor；Clinicopathology； Immunohistochemistry 　　胃肠间质瘤（gastrointestinal stromal tumor，GIST）是一类以CD117蛋白表达阳性为特征的间叶源性肿瘤，可以发生在消化道的任何部位，以胃最为常见，占60%～70%，其次为小肠，占20%～30%[1]。小肠胃肠间质瘤和发生在胃的胃肠间质瘤一样，这些病变最初被认为是平滑肌肿瘤[2]。小肠胃肠间质瘤多见于空肠，其次分别为回肠和十二指肠，男性稍多。小肠GIST的恶性率为35%