中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2014年
21期
1368-1373
,共6页
耿振宏%孙希印%魏超%韩莹%董艳光%李新功
耿振宏%孫希印%魏超%韓瑩%董豔光%李新功
경진굉%손희인%위초%한형%동염광%리신공
胃肠间质瘤%病理学%癌
胃腸間質瘤%病理學%癌
위장간질류%병이학%암
gastrointestinal stromal tumor%pathology%carcinoma
目的：研究与消化道癌并发的胃肠间质瘤（gastrointestinal stromal tumor，GIST）的临床病理特点。方法：对胜利石油管理局胜利医院、胜利油田中心医院、东营市人民医院2002年1月至2012年12月收治的157例胃肠间质瘤病例，观察CD117、CD34、SMA免疫组织化学标记的表达。观察并发胃肠道癌病例的临床病理特点，重点观察肿瘤异型性、核分裂活性、细胞增殖活性标记物Ki-67的表达特点，与未并发胃肠道癌的病例进行比较。结果：157例中并发胃肠道癌者24例，占15.3%。其中男14例，女10例，男女之比为1.4∶1。年龄41岁～66岁，中位年龄55岁。24例中7例位于食管中段或下段，15例位于胃壁，2例位于空肠。肿瘤直径0.6～3.8 cm，平均（1.50±0.85）cm，4例有轻度异型性，其余无异型性。核有丝分裂0～5个/50HPF，平均（0.79±1.83）个/50 HPF，Ki-67指数0～7.72，平均2.16±3.26。并发癌瘤包括食管癌5例，胃食管交界处癌2例，胃癌15例，肠癌2例。作为对照，未并发消化道癌的胃肠道间质瘤患者133例，其中男74例，女59例，男女之比为1.25∶1。年龄43～71岁，中位年龄54岁。114例发生于胃，13例位于肠，6例食管。肿瘤直径2.4～15.5 cm，平均（6.11±7.09）cm。82例显示不同程度的异型性，68例诊断为中危险度，14例为高危险度。核有丝分裂0～53个/50 HPF，平均（3.81±23.67）个/50 HPF。Ki-67指数0～39.21，平均6.22±16.96。并发癌的胃肠间质瘤较未并发癌者比较，男女病例比值较高，瘤体平均直径较小，核分裂指数和Ki-67阳性指数显著较低（分别为t=1.981，P<0.05；t=1.9935，P<0.05）。结论：15.3%胃肠间质瘤是并发癌。并发的胃肠间质瘤多数没有特殊临床症状，因癌手术后标本大体检查时发现。其增殖活性显著低于未并发癌的胃肠间质瘤，可能属于发生早期的肿瘤。
目的：研究與消化道癌併髮的胃腸間質瘤（gastrointestinal stromal tumor，GIST）的臨床病理特點。方法：對勝利石油管理跼勝利醫院、勝利油田中心醫院、東營市人民醫院2002年1月至2012年12月收治的157例胃腸間質瘤病例，觀察CD117、CD34、SMA免疫組織化學標記的錶達。觀察併髮胃腸道癌病例的臨床病理特點，重點觀察腫瘤異型性、覈分裂活性、細胞增殖活性標記物Ki-67的錶達特點，與未併髮胃腸道癌的病例進行比較。結果：157例中併髮胃腸道癌者24例，佔15.3%。其中男14例，女10例，男女之比為1.4∶1。年齡41歲～66歲，中位年齡55歲。24例中7例位于食管中段或下段，15例位于胃壁，2例位于空腸。腫瘤直徑0.6～3.8 cm，平均（1.50±0.85）cm，4例有輕度異型性，其餘無異型性。覈有絲分裂0～5箇/50HPF，平均（0.79±1.83）箇/50 HPF，Ki-67指數0～7.72，平均2.16±3.26。併髮癌瘤包括食管癌5例，胃食管交界處癌2例，胃癌15例，腸癌2例。作為對照，未併髮消化道癌的胃腸道間質瘤患者133例，其中男74例，女59例，男女之比為1.25∶1。年齡43～71歲，中位年齡54歲。114例髮生于胃，13例位于腸，6例食管。腫瘤直徑2.4～15.5 cm，平均（6.11±7.09）cm。82例顯示不同程度的異型性，68例診斷為中危險度，14例為高危險度。覈有絲分裂0～53箇/50 HPF，平均（3.81±23.67）箇/50 HPF。Ki-67指數0～39.21，平均6.22±16.96。併髮癌的胃腸間質瘤較未併髮癌者比較，男女病例比值較高，瘤體平均直徑較小，覈分裂指數和Ki-67暘性指數顯著較低（分彆為t=1.981，P<0.05；t=1.9935，P<0.05）。結論：15.3%胃腸間質瘤是併髮癌。併髮的胃腸間質瘤多數沒有特殊臨床癥狀，因癌手術後標本大體檢查時髮現。其增殖活性顯著低于未併髮癌的胃腸間質瘤，可能屬于髮生早期的腫瘤。
목적：연구여소화도암병발적위장간질류（gastrointestinal stromal tumor，GIST）적림상병리특점。방법：대성리석유관리국성리의원、성리유전중심의원、동영시인민의원2002년1월지2012년12월수치적157례위장간질류병례，관찰CD117、CD34、SMA면역조직화학표기적표체。관찰병발위장도암병례적림상병리특점，중점관찰종류이형성、핵분렬활성、세포증식활성표기물Ki-67적표체특점，여미병발위장도암적병례진행비교。결과：157례중병발위장도암자24례，점15.3%。기중남14례，녀10례，남녀지비위1.4∶1。년령41세～66세，중위년령55세。24례중7례위우식관중단혹하단，15례위우위벽，2례위우공장。종류직경0.6～3.8 cm，평균（1.50±0.85）cm，4례유경도이형성，기여무이형성。핵유사분렬0～5개/50HPF，평균（0.79±1.83）개/50 HPF，Ki-67지수0～7.72，평균2.16±3.26。병발암류포괄식관암5례，위식관교계처암2례，위암15례，장암2례。작위대조，미병발소화도암적위장도간질류환자133례，기중남74례，녀59례，남녀지비위1.25∶1。년령43～71세，중위년령54세。114례발생우위，13례위우장，6례식관。종류직경2.4～15.5 cm，평균（6.11±7.09）cm。82례현시불동정도적이형성，68례진단위중위험도，14례위고위험도。핵유사분렬0～53개/50 HPF，평균（3.81±23.67）개/50 HPF。Ki-67지수0～39.21，평균6.22±16.96。병발암적위장간질류교미병발암자비교，남녀병례비치교고，류체평균직경교소，핵분렬지수화Ki-67양성지수현저교저（분별위t=1.981，P<0.05；t=1.9935，P<0.05）。결론：15.3%위장간질류시병발암。병발적위장간질류다수몰유특수림상증상，인암수술후표본대체검사시발현。기증식활성현저저우미병발암적위장간질류，가능속우발생조기적종류。
Objective:To observe the clinicopathological features of gastrointestinal stromal tumor (GIST) cases with concurrent carcinoma. Methods:Patient data of 24 GIST cases with concurrent carcinoma were collected from the 157 GIST cases reported be-tween 2002 and 2012. The clinicopathological features of the GIST cases with concomitant carcinoma were studied. The expression of CD117, CD34, and SMA by the tumors was assayed using the immunohistochemical EliVision method. In particular, the expression of the proliferation marker Ki-67 was studied. Results:GIST cases with concurrent carcinoma accounted for 15.3%of the total GIST cas-es studied. The GIST patients with concurrent carcinoma included 14 males and 10 females. The male-female ratio of these patients was 1.4∶1. The age of the patients ranged from 41 years to 66 years, with a median age of 55 years. Lesions at the inferior segment of the esophagus were found in 7 of the 24 selected GIST cases;lesions at the gastric wall and in the intestines were observed in 15 and 2 cas-es, respectively. The diameter of the GIST cases with concurrent carcinoma ranged between 0.6 and 3.8 cm, with an average of 1.50 ± 0.85 cm. Slight dysplasia was observed in 4 of the 24 cases; no heteromorphism was present in the remaining 20 cases. The mitotic counts of GIST cases with concurrent carcinoma ranged from 0/50 HPF to 5/50 HPF, with an average of (0.79±1.83)/50 HPF. The pro-liferative index of Ki-67 in the GIST cases with concurrent carcinoma ranged between 0 and 7.72, with an average of 2.16 ± 3.26. The concurrent carcinoma cases included 5 cases with esophageal carcinoma, 2 with cardiac carcinoma, 15 with gastric cancer, and 2 with intestinal cancer. In contrast to the GIST cases with concurrent carcinoma, the GIST cases without carcinoma complications included 74 males and 59 females. The male-female ratio was 1.25∶1. The age of the patients without concurrent carcinoma ranged from 43 years to 71 years, with a median age of 54 years. Among the 133 GIST cases without cancer complications, gastric, intestinal, and esophageal lesions were found in 114, 13, and 6 cases, respectively. The diameter of GISTs without cancerous complications ranged from 2.4 cm to 15.5 cm, with an average of 6.11 ± 7.09 cm. Different degrees of dysplasia were seen in 82 of the 133 cases. The mitotic counts in the GIST cases without cancer complications ranged from 0/50 HPF to 53/50 HPF, with an average of (3.81±23.67)/50 HPF. The prolifera-tive index of Ki-67 for these cases ranged from 0 to 39.21 and averaged at 6.22 ± 16.96. The male-female ratio of the GIST cases with cancer complications was higher compared with the GIST cases without. The average diameter of GISTs with complications was small-er compared with that of GISTs without complications. The mitotic counts and the proliferative index of Ki-67 were significantly lower in the GIST cases with cancer complications than in those without (t=1.981, P<0.05 vs. t=1.993 5, P<0.05). Conclusion:Concurrent car-cinomas were found in 15.3% of the total GIST cases. No special clinical symptoms were observed in most GIST cases with cancer complications, as revealed when the carcinomas were examined. The proliferative index of Ki-67 in the GIST cases with concurrent car-cinoma is significantly lower compared with that of the GIST cases without complications.
