Sun Xi-yin, Wu Qi-song, Geng Zhen-hong, Li Qing, Wang Lin-lin, Li Xin-gong
Department of Pathology, Dongying People's Hospital, Dongying 257091, China.
E-mail:
Zhonghua Bing Li Xue Za Zhi. 2013 Nov;42(11):739-43.
To evaluate the clinicopathologic features of gastrointestinal stromal tumor (GIST) with synchronous carcinoma and the treatment principle.
Nineteen cases of GIST with synchronous carcinoma were collected from 113 cases of GIST from 2002 to 2008. The clinicopathologic features were studied and the expression of CD117, CD34, smooth muscle actin and S-100 protein were detected by immunohistochemistry using EliVision method. The expression of proliferation marker Ki-67 was also studied. GIST with synchronous carcinoma and those without carcinoma were compared.
Nineteen cases (16.8%) of GIST with synchronous carcinoma were found, including 11 males and 8 females (male to female ratio 1.38: 1.00). The age of the patients ranged from 43 to 66 years (median age 57 years). Five of 19 cases were located in the inferior segment of esophagus and 14 were in the gastric wall. The diameter ranged from 0.6 to 3.8 cm [mean (1.91 ± 0.92) cm]. Three of 19 cases showed low grade dysplasia, and there was no dysplasia in the remaining 16 cases. The number of mitosis ranged from 0 to 4/50 HPF [mean (0.74 ± 1.07)/50 HPF]. The Ki-67 proliferative index (number of Ki-67 positive cell/HPF) ranged from 0 to 7.72% [mean (2.51 ± 2.20)%]. The synchronous carcinomas included two esophageal carcinomas and 17 gastric cancers.In contrast, patients of GIST without carcinoma included 52 males and 42 females (male to female ratio 1.24: 1.00). The age of patients ranged from 43 to 71 years (median age 55 years). Seventy-nine of the 94 cases were located in the stomach, 10 were in the intestine and 5 were in the esophagus. The diameter ranged from 2.4 to 15.5 cm [mean (5.42 ± 6.17) cm].Seventy-nine of the 94 cases showed variable degrees of dysplasia, and 12 cases were of high malignant potential. The number of mitosis ranged from 0 to 53/50 HPF [average (3.78 ± 10.22)/50 HPF]. The Ki-67 proliferative index ranged from 0 to 37.54% [mean (6.78 ± 12.45)%]. Comparing these two groups, the male to female ratio of GIST with synchronous carcinoma was higher than that of GIST without carcinoma. The average diameter of GIST with synchronous carcinoma was smaller than of those without carcinoma. The number of mitosis and Ki-67 proliferative index of GIST with synchronous carcinoma were significantly lower than those without carcinoma (t' = 2.809, P < 0.05; t' = 3.095, P < 0.05, respectively).
Sixteen point eight percent of GIST may be associated with synchronous carcinoma. There are no special clinical symptoms in most of GIST with synchronous carcinoma, as these GIST are usually incidental findings. The Ki-67 proliferative index of GIST with synchronous carcinoma is significantly lower than that of GIST without synchronous carcinoma. Most GIST with synchronous carcinoma can be treated by the standard treatment for the accompanying carcinoma, and do not require specific additional treatments.
评估胃肠道间质瘤（GIST）合并同时性癌的临床病理特征及治疗原则。
从2002年至2008年的113例GIST病例中收集到19例GIST合并同时性癌的病例。研究其临床病理特征，采用EliVision法免疫组织化学检测CD117、CD34、平滑肌肌动蛋白和S-100蛋白的表达。同时研究增殖标志物Ki-67的表达。对GIST合并同时性癌和不合并癌的病例进行比较。
发现19例（16.8%）GIST合并同时性癌，其中男性11例，女性8例（男女比例1.38∶1.00）。患者年龄43～66岁（中位年龄57岁）。19例中5例位于食管下段，14例位于胃壁。直径0.6～3.8 cm[平均（1.91±0.92）cm]。19例中3例显示低级别异型增生，其余16例无异型增生。核分裂象数0～4/50 HPF[平均（0.74±1.07）/50 HPF]。Ki-67增殖指数（Ki-67阳性细胞数/HPF）0～7.72%[平均（2.51±2.20）%]。同时性癌包括2例食管癌和17例胃癌。相比之下，不合并癌的GIST患者中男性52例，女性42例（男女比例1.24∶1.00）。患者年龄43～71岁（中位年龄55岁）。94例中79例位于胃，10例位于小肠，5例位于食管。直径2.4～15.5 cm[平均（5.42±6.17）cm]。94例中79例显示不同程度的异型增生，12例具有高恶性潜能。核分裂象数0～53/50 HPF[平均（3.78±10.22）/50 HPF]。Ki-67增殖指数0～37.54%[平均（6.78±12.45）%]。比较这两组，GIST合并同时性癌的男女比例高于不合并癌的GIST。GIST合并同时性癌的平均直径小于不合并癌的GIST。GIST合并同时性癌的核分裂象数和Ki-67增殖指数显著低于不合并癌的GIST（t′=2.809，P<0.05；t′=3.095，P<0.05）。
16.8%的GIST可能合并同时性癌。大多数GIST合并同时性癌无特殊临床症状，通常为偶然发现。GIST合并同时性癌的Ki-67增殖指数显著低于不合并同时性癌的GIST。大多数GIST合并同时性癌可采用伴随癌的标准治疗，无需特殊的额外治疗。
