侯英勇同时和异时性多发性胃肠道间质瘤.ppt

同时和异时性多发性胃肠道间质瘤Synchronous and metachronous sporadic multiple GIST 侯英勇 复旦大学附属中山医院病理科 Aims Sporadic multiple gastrointestinal stromal tumor (GISTs) especially metachronous GISTs are extremely rare The metachronous GISTs raise the challenge in adjuvant therapy in imatinib era The aim of this study was to investigate the clinical, phenotype, genetic characteristic, and biological behavior of synchronous and metachronous GISTs Methods Retrospectively investigation from archive file of Zhongshan Hospital Dec 2002 to Dec 2009 427 primary GIST+195 consultant patient (622 cases) Thirty-two paraffin blocks of multiple GISTs and 15 normal tissues were obtained Reviewing HE slides Immunohistochemical staining KIT and PDGFRA gene mutation analysis Results the frequency of occurrence was 2.4% (15/622) There were 5 males and 10 females the age at diagnosis ranged from 49 to 84 years (mean 66.9 years) 13 patients had synchronous GISTs the number of GIST were 2 in 11 patients and 3 in 2 patients Two patients was defined as metachronous GIST one had a new gastic GIST 7 month after the initial duodenal GIST surgery one had a new gastric GIST 43 months after the initial gastric GIST resection A total of 31 gastric GIST and 1 duodenal GIST from 15 patients were available The tumor sizes ranged from 0.2 to 12 cm (mean 2.7 cm) The size ratio of different tumors in each patient ranged from 1.2 to 12 (median 3.2 and mean 5.4) Spindle shaped in 27 (84.3%), mixed cell type in 3 (9.4%), and epithelioid cell type in 2 (6.3%) Histopathological patterns within a patient were uniform in 12 patients, 3 patients presented with different cell shape in each tumor mass Mitotic figures were 0 in 20 GISTs, 1 in 3 GISTs, 2 in 1 GISTs, 3 in 1 GIST, 4 in 3 GISTs, 5 in 1 GIST, 7 in 1 GIST, 9 in 1 GIST and 25 in 1 GIST per 50 high-power fields Nonmalignant in 26 GISTs, low malignant in 6 GISTs CD117 were positive in 90.6% of multiple GISTs (29/32) CD34, smooth muscle actin (SMA), S-1