CAJ | 학술논문

目的探讨上皮样胃肠道间质瘤（gastrointestinal stromal tumors，GIST）的临床病理学特征。方法对43例上皮样GIST患者进行常规病理、免疫组化标记。结果本组上皮样GIST患者的男女之比为1.7∶1，平均年龄60岁。肿瘤以胃、腹盆腔为多见，其中复发6例，发生肝转移4例。镜下肿瘤细胞以圆形、卵圆形或短梭形为主，胞浆丰富透明或嗜酸，可见透明空泡状及印戒样细胞。可形成微囊状结构，成片状、巢状，可见纤细或粗大的纤维分隔，部分可见腺管样结构。6例复发病例中有2例原发为梭形细胞型（余不详）。CD117、CD34、DOG1的阳性率分别为79.07%，73.81%，84.85%，3例CD117阴性病例DOG1阳性表达。有4例CD117、DOG1均阴性， CD34却阳性表达。结论上皮样GIST具有上皮样肿瘤的形态学特点，易发生误诊，应予以仔细鉴别。梭形细胞型GIST复发，可发生上皮样的改变。在上皮样GIST中DOG1的阳性率高于CD117，CD117、CD34、DOG1联合应用可提高诊断准确率。
목적탐토상피양위장도간질류（gastrointestinal stromal tumors，GIST）적림상병이학특정。방법대43례상피양GIST환자진행상규병리、면역조화표기。결과본조상피양GIST환자적남녀지비위1.7∶1，평균년령60세。종류이위、복분강위다견，기중복발6례，발생간전이4례。경하종류세포이원형、란원형혹단사형위주，포장봉부투명혹기산，가견투명공포상급인계양세포。가형성미낭상결구，성편상、소상，가견섬세혹조대적섬유분격，부분가견선관양결구。6례복발병례중유2례원발위사형세포형（여불상）。CD117、CD34、DOG1적양성솔분별위79.07%，73.81%，84.85%，3례CD117음성병례DOG1양성표체。유4례CD117、DOG1균음성， CD34각양성표체。결론상피양GIST구유상피양종류적형태학특점，역발생오진，응여이자세감별。사형세포형GIST복발，가발생상피양적개변。재상피양GIST중DOG1적양성솔고우CD117，CD117、CD34、DOG1연합응용가제고진단준학솔。
Objective To investigate clinicopathological features of epithelioid gastrointestinal stromal tumors (gastrointestinal stromal tumors,GIST).Methods By routine pathological and immunohistochemical markers,43 epithelioid GIST cases were observed and clinicopathological features was discussed and analyzed. Results The ratio of male to female was 1.7∶1. The average age was 60 years old.Most were located at stomach,abdominal and pelvic.6 cases were recurrence and 4 cases metastasized to the liver among all cases.Microscopically, the tumor mainly consisted of round,oval or short spindle cells with abundant cytoplasm which were transparent or eosinophilic. In some cases transparent vacuoles cells and signet ring-like cells were observed,which were separated by slender or thick fiber, could formed into microcapsule structure,sheets or nests. Duct-like structure could be found in some cases. 2 cases of primary GIST were in spindle cell type in the six recurrent cases (Others was unknown). The tumors were positive for CD117 79.07%, CD34 73.81%, DOG1 84.85%. Three cases of CD117 negative expressed DOG1 positive. It was worth mentioning that CD117 and DOG1 were negative,while CD34 was positive in four cases.Conclusion Epithelioid GIST possessed characteristics of epithelioid tumors in morphology,so it was easy misdiagnosed and should be identified.When GIST of Spindle cell recurred,it would have occurrence of epithelioid change.The positive rate of DOG1 of epithelioid GIST was higher than that of CD117. However,the difference was not statistically significant.Morphological features of epithelioid GIST with epithelioid tumor, was prone to misdiagnosis, should be careful to identify. Spindle cell type GIST recurred, epithelioid changes could occurred. The positive rate of DOG1 in epithelioid GIST was higher than that of CD117. The combination of CD117,CD34,DOG1 could improve the accuracy rate of diagnosis.