24例与癌并发的胃肠间质瘤临床病理分析
Clinicopathological characteristics of 24 gastrointestinal stromal tumor cases with concurrent carcinoma
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摘要: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=1.993 5, 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Abstract: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 between 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 cases 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 cases, 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 proliferative 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 proliferative 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 smaller 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 carcinomas 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 carcinoma is significantly lower compared with that of the GIST cases without complications.
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