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目的探讨3种胃肠梭形细胞肿瘤的临床病理特点及诊断与鉴别诊断。方法复习49例胃肠梭形细胞肿瘤的HE切片并行免疫组化染色,重新明确诊断,对每类肿瘤的临床病理资料和组织形态进行分析。结果根据免疫组化结果分类:①胃肠道间质瘤39例(39/49),中位年龄56岁;其中胃23例,19例发生于胃底、体部;小肠7例,结直肠3例,食管2例,肠系膜及网膜4例。光镜见瘤细胞梭形和/或上皮样,排列成交叉束状、栅栏状、假菊形团样、弥漫状等,其中24例可见间质灶状水肿区,14例伴有不同程度的炎细胞浸润。②胃肠平滑肌瘤6例(6/49),中位年龄37.5岁;2例位于食管,4例发生于胃,其中3例位于胃贲门。肿瘤细胞呈梭形、温和,2例伴有灶性钙化。③施万瘤4例(4/49),中位年龄48岁;均位于胃,其中3例位于胃体,1例胃窦。光镜下4例均见淋巴细胞套,3例见细胞密集与稀疏交替区,3例见局灶异型细胞,核分裂罕见。结论胃肠梭形细胞肿瘤几乎均为间叶起源,其中胃肠间质瘤最常见,但平滑肌瘤与施万瘤仍然存在。与间质瘤和施万瘤相比,平滑肌瘤发病年龄较低。前两者好发于胃底、体部,平滑肌瘤好发于消化道上段。各类肿瘤形态学具有部分可识别的特征,但明确诊断有赖于免疫组化。
Objective To investigate the clinicopathological characteristics, diagnosis and differential diagnosis of three kinds of gastrointestinal spindle cell tumors. Methods 49 cases of gastrointestinal spindle cell tumor HE section parallel immunohistochemical staining, re-definite diagnosis of each type of tumor clinical and pathological data and tissue morphology were analyzed. Results According to the results of immunohistochemistry, there were 39 cases (39/49) of gastrointestinal stromal tumors, with a median age of 56 years. Among them, 23 cases had stomach and 19 cases had gastric fundus and body; 7 cases of small intestine, 3 cases, 2 cases of esophagus, mesentery and omentum in 4 cases. Light microscopic tumor cells spindle and / or epithelial, arranged in cross-beam, palisading, false daisy-like, diffuse and so on, of which 24 cases can be seen interstitial focal edema area, 14 cases with varying degrees of Inflammatory cell infiltration. ② gastrointestinal leiomyoma in 6 cases (6/49), the median age of 37.5 years; 2 cases located in the esophagus, 4 cases occurred in the stomach, of which 3 were located in the stomach cardia. Tumor cells were fusiform, mild, 2 cases with focal calcification. ③ Schwannoma in 4 cases (4/49), the median age of 48 years; are located in the stomach, of which 3 were located in the stomach, 1 case of the antrum. Light microscope, 4 cases were seen lymphocyte sets, 3 cases of cell dense and sparse alternating areas, 3 cases of focal abnormal cells see, rare cases of mitosis. Conclusions Most gastrointestinal spindle cell tumors are mesenchymal origins, of which gastrointestinal stromal tumors are the most common, but leiomyomas and Shiwan tumors still exist. Compared with stromal tumors and Shiwan tumor, the incidence of leiomyoma is lower. The first two occur in the stomach, body, leiomyoma occur in the upper gastrointestinal tract. Various types of tumor morphology with some identifiable features, but a clear diagnosis depends on immunohistochemistry.