Lin Shee-Chan, Huang Ming-Jer, Zeng Chen-Yuan, Wang Tzang-In, Liu Zen-Liang, Shiay Ray-Kuan
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China.
World J Gastroenterol. 2003 Dec;9(12):2809-12. doi: 10.3748/wjg.v9.i12.2809.
To investigate the incidence of CD117-positive immunohistochemical staining in previously diagnosed gastrointestinal (GI) tract stromal tumors (GIST) and to analyze the tumors' clinical manifestations and prognostic factors.
We retrospectively reviewed 91 cases with a previous diagnosis of GI stromal tumor, leiomyoma, or leiomyosarcoma. Tissue samples were assessed with CD117, CD34, SMA and S100 immunohistochemical staining. Clinical and pathological characteristics were analyzed for prognostic factors.
CD117 was positive in 81 (89%) of 91 tissue samples. There were 59 cases (72.8%) positive for CD34, 13 (16%) positive for SMA, and 12 (14.8%) positive for S100. There was no gender difference in patients with CD117-positive GIST. Their mean age was 65 years. There were 44 (54%) tumors located in the stomach and 29 (36%) in the small intestine. The most frequent presenting symptoms were abdominal pain and GI bleeding. The mean tumor size was 7.5 +/- 5.7 cm. There were 35 cases (43.2%) with tumors >5 cm. The tumor size correlated significantly with tumor mitotic count and resectability. Tumor size, mitotic count, and resectability correlated significantly with tumor recurrence and survival. There was recurrent disease in 39% of our patients, and their mean survival after recurrence was 16.6 months. Most recurrences were at the primary site or metastatic to the liver. Twenty-six percent of our patients died of their disease.
Traditional histologic criteria are not specific enough to diagnose GIST. This diagnosis must be confirmed with CD117 immunohistochemical staining. Prognosis is dependent on tumor size, mitotic count, and resectability.
研究既往诊断的胃肠道间质瘤（GIST）中CD117免疫组化染色的发生率，并分析肿瘤的临床表现及预后因素。
我们回顾性分析了91例既往诊断为胃肠道间质瘤、平滑肌瘤或平滑肌肉瘤的病例。组织样本进行CD117、CD34、平滑肌肌动蛋白（SMA）和S100免疫组化染色评估。分析临床和病理特征以寻找预后因素。
91份组织样本中81份（89%）CD117呈阳性。CD34阳性59例（72.8%），SMA阳性13例（16%），S100阳性12例（14.8%）。CD117阳性的GIST患者无性别差异。他们的平均年龄为65岁。44例（54%）肿瘤位于胃，29例（36%）位于小肠。最常见的症状是腹痛和胃肠道出血。肿瘤平均大小为7.5±5.7cm。35例（43.2%）肿瘤直径>5cm。肿瘤大小与肿瘤有丝分裂计数及可切除性显著相关。肿瘤大小、有丝分裂计数和可切除性与肿瘤复发及生存显著相关。39%的患者出现疾病复发，复发后的平均生存时间为16.6个月。大多数复发发生在原发部位或转移至肝脏。26%的患者死于该疾病。
传统组织学标准不足以诊断GIST。必须通过CD117免疫组化染色来确诊。预后取决于肿瘤大小、有丝分裂计数和可切除性。
