Appelman H D
Am J Surg Pathol. 1986;10 Suppl 1:83-99.
Arthur Purdy Stout and his co-workers, in several publications, raised two important issues concerning gut stromal tumors. First, they felt that all were of smooth muscle origin. Recent ultrastructural and immunohistochemical studies suggest that the component cells are basically undifferentiated, and there is only occasional emergence of smooth muscle features and, in some tumors, possibly features of other cell types as well, such as Schwann cells. Second, Stout felt that the high mitotic rate was the best predictor of malignancy, but he recognized that some tumors, even with low rates, could metastasize. Surprisingly, recent studies, even those covering large series, have done little to dispute these contentions. However, current data suggest that the diagnosis of malignancy can be made using multiple parameters, not all of which must be present in every sarcoma. These parameters include, in addition to mitotic rate, the size, gross invasion of adjacent organs, and cellularity, and all of these must be modified according to the location in the gut and the pattern of growth.
亚瑟·珀迪·斯托特及其同事在多篇出版物中提出了两个关于肠道间质瘤的重要问题。首先，他们认为所有肠道间质瘤均起源于平滑肌。近期的超微结构和免疫组织化学研究表明，组成细胞基本未分化，仅偶尔出现平滑肌特征，在某些肿瘤中还可能出现其他细胞类型的特征，如施万细胞。其次，斯托特认为高有丝分裂率是恶性肿瘤的最佳预测指标，但他也认识到一些肿瘤即使有丝分裂率低也可能发生转移。令人惊讶的是，近期的研究，即使是那些涵盖大量病例的研究，也几乎没有对这些观点提出质疑。然而，目前的数据表明，可以使用多个参数来诊断恶性肿瘤，并非每个肉瘤都必须具备所有这些参数。这些参数除了有丝分裂率外，还包括肿瘤大小、对相邻器官的大体侵犯情况以及细胞密度，并且所有这些参数都必须根据肿瘤在肠道中的位置和生长方式进行调整。
