Elliott Danielle D, Fanning Christina V, Caraway Nancy P
Division of Pathology and Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2006 Feb 25;108(1):49-55. doi: 10.1002/cncr.21376.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the tubular gut and mesentery. Fine-needle aspiration biopsy (FNAB) currently is a useful tool in the diagnosis of GIST because of various mutations of the KIT protooncogene that are recognized as characteristic of these tumors. Despite such advances, the malignant potential of GIST remains variable, and few studies have reported their findings in patients with malignant GIST. Therefore, in the current study, the authors have reported their experience with FNAB as a diagnostic tool in one of the largest series of malignant GISTs and have analyzed the cytomorphologic features of the tumors relative to their clinical behavior to determine which, if any, cytologic features are indicators of malignancy.
All patients with histologically confirmed GIST who were diagnosed by image-guided FNAB and confirmed with positive CD117 staining from 1998 to 2003 were included in the study. All tumors were reviewed for various cytomorphologic features. For study purposes, the patients were divided into two groups: Group A included all patients with malignant tumors, defined as those with metastatic disease or recurrent disease after adequate surgery with or without chemotherapy; Group B included all other patients.
In total, 26 tumors from 23 patients (8 males and 15 females) with a mean age of 60.9 years were available for review. There were 14 primary tumors, 7 metastases (to the liver), and 5 recurrences. Twenty-one tumors were unequivocally malignant and were placed into Group A; the remaining 5 tumors were placed into Group B. The tumors in both groups were characterized by spindled or epithelioid cells with minimal nuclear atypia or pleomorphism and a moderate amount of cytoplasm. None of the cytologic features that were evaluated could distinguish reliably between benign tumors and malignant tumors, as expected. However, on cytologic examination, all tumors that demonstrated mitoses (n = 7 tumors) and/or pretreatment necrosis (n = 3 tumors) were identified as malignant.
FNAB remains a reliable method for the diagnosis of GIST. Immunohistochemical staining of cytologic material with CD117 has been reliable in establishing this diagnosis by FNAB, provided adequate tissue is procured. In the current study, the presence of necrosis or mitoses in cytologic specimens was correlated with a diagnosis of malignant GIST.
胃肠道间质瘤（GISTs）是管状肠道和肠系膜最常见的间叶性肿瘤。由于KIT原癌基因的各种突变被认为是这些肿瘤的特征，细针穿刺活检（FNAB）目前是诊断GIST的一种有用工具。尽管有这些进展，GIST的恶性潜能仍然存在差异，很少有研究报道其在恶性GIST患者中的发现。因此，在本研究中，作者报告了他们在最大系列的恶性GIST之一中使用FNAB作为诊断工具的经验，并分析了肿瘤的细胞形态学特征与其临床行为的关系，以确定哪些细胞特征（如果有的话）是恶性的指标。
本研究纳入了1998年至2003年期间经组织学证实为GIST、通过影像引导下FNAB诊断且CD117染色阳性的所有患者。对所有肿瘤的各种细胞形态学特征进行了复查。为了研究目的，将患者分为两组：A组包括所有恶性肿瘤患者，定义为在充分手术（无论是否接受化疗）后出现转移性疾病或复发性疾病的患者；B组包括所有其他患者。
总共对23例患者（8例男性和15例女性）的26个肿瘤进行了复查，平均年龄为60.9岁。其中有14个原发性肿瘤、7个转移瘤（至肝脏）和5个复发病灶。21个肿瘤明确为恶性，归入A组；其余5个肿瘤归入B组。两组肿瘤均以梭形或上皮样细胞为特征，核异型性或多形性最小，胞质中等量。正如预期的那样，所评估的任何细胞特征都不能可靠地区分良性肿瘤和恶性肿瘤。然而，在细胞学检查中，所有显示有丝分裂（n = 7个肿瘤）和/或预处理前坏死（n = 3个肿瘤）的肿瘤均被确定为恶性。
FNAB仍然是诊断GIST的可靠方法。只要获取足够的组织，用CD117对细胞学材料进行免疫组织化学染色在通过FNAB建立该诊断方面一直是可靠的。在本研究中，细胞学标本中坏死或有丝分裂的存在与恶性GIST的诊断相关。
