Fülöp Emoke, Marcu Simona, Borda Angela, Moldovan C, Fülöp E F, Loghin Andrada, Pávai Z
Department of Histology, University of Medicine and Pharmacy of Targu Mures, Romania.
Rom J Morphol Embryol. 2011;52(2):555-62.
Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract. Major advances in their definition and classification and the understanding of their molecular mechanisms have recently been made. These advances have become a model of targeted therapy in oncology. The diagnosis of GISTs relies on histological arguments - proliferation of spindle cells, seldom of epithelioid cells or both spindle and epithelioid cells - and on immunohistochemical arguments - expression of CD117 usually associated with CD34 expression. The evaluation of the prognosis is essential and based on a simple algorithm using two prognostic parameters, tumor size and mitotic index. The aim of this paper is a complex histopathological assessment, using both classic and modern (immunohistochemistry) techniques, of the GISTs comprised in the study. GISTs occur mainly in older adults (median age 60-69 years), anywhere along the gastrointestinal tract but also retroperitoneal. Most of them were nodular (75%), tumor necrosis and mucosal ulceration being the most frequent encountered secondary alterations; these modifications proved to be significantly correlated with large tumor size and high malignancy. Immunohistochemical evaluation revealed that 77 (97%) cases of GISTs presented a positive reaction for CD117, 50 (63%) cases were positive for CD34, 19 (24%) were positive for SMA and only 10 (13%) were positive for S100. Immunohistochemical evaluation remains an important tool of pathology in the diagnosis of GISTs, in the differential diagnosis from other gastrointestinal mesenchymal tumors and represents the gold standard for diagnosis of these tumors and an eligibility criterion for imatinib therapy.
胃肠道间质瘤（GISTs）是胃肠道最常见的间叶组织肿瘤。近年来，在其定义、分类以及分子机制的理解方面取得了重大进展。这些进展已成为肿瘤学中靶向治疗的典范。GISTs的诊断依赖于组织学依据——梭形细胞增生，很少见上皮样细胞增生或梭形与上皮样细胞同时增生——以及免疫组化依据——CD117表达通常与CD34表达相关。预后评估至关重要，基于一个使用肿瘤大小和有丝分裂指数这两个预后参数的简单算法。本文的目的是运用经典和现代（免疫组化）技术，对研究中包含的GISTs进行综合组织病理学评估。GISTs主要发生于老年人（中位年龄60 - 69岁），可出现在胃肠道的任何部位，也可发生于腹膜后。其中大多数为结节状（75%），肿瘤坏死和黏膜溃疡是最常见的继发性改变；这些改变与肿瘤体积大及高恶性显著相关。免疫组化评估显示，77例（97%）GISTs病例CD117呈阳性反应，50例（63%）CD34呈阳性，19例（24%）平滑肌肌动蛋白（SMA）呈阳性，仅10例（13%）S100呈阳性。免疫组化评估仍然是病理学诊断GISTs的重要工具，有助于与其他胃肠道间叶组织肿瘤进行鉴别诊断，是这些肿瘤诊断的金标准以及伊马替尼治疗的入选标准。
