刘贵平 向鑫 刘清松 谢孝川 敬敏 王瑜 谷从阳

[摘要] 目的 肝脏是胃肠间质瘤常见转移部位，该研究旨在探讨分析肝转移性胃肠间质瘤的临床病理特征和免疫组织化学表达及综合治疗策略。 方法 回顾性分析内江市第一人民医院2005年1月—2015年1月6例GIST肝转移病例免疫组化染色特点，并结合复习相关文献对其进行临床病理分析。 结果 本组6例GIST肝转移病例中，3例原发灶来自胃，2例原发灶来自小肠，1例来自大网膜。肿瘤直径3.5～15 cm，组织学分型：梭形细胞型、上皮样细胞型、混合型，免疫组化：肿瘤弥漫性表达CD117（83.3%）、DOG-1（83.3%）、CD34（66.7%）。肝脏肿瘤复发时间与原发肿瘤恶性程度分级有一定相关性，肝转移灶核分裂像相对于原发灶有所改变。 结论 肝转移性胃肠间质瘤病理组织学特点和原发灶相似，诊断主要依据CD117，DOG1弥漫阳性表达，目前手术完整切除联合甲磺酸伊马替尼为主要治疗措施。

[关键词] 肝脏；肿瘤；胃肠道间质瘤；病理

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2016）02（a）-0045-03

Analysis of Pathologic Features and Clinical Treatment and Diagnosis of Liver Metastasis Gastrointestinal Stromal Tumor

LIU Gui-ping， XIANG Xin， LIU Qing-song， XIE Xiao-chuan， JING Min， WANG Yu， GU Cong-yang

Department of Pathology， Neijiang first people's Hospital， Neijiang， Sichuan Province， 641000 China

[Abstract] Objective Liver is the common metastatic site of gastrointestinal stromal tumors， this study is aimed at discussing and analyzing the clinical pathologic features and immunohistochemical expression and comprehensive treatment strategies. Methods The immunohistochemical staining characteristics of 6 cases with liver metastasis GIST treated in the Neijiang first people's Hospital from January 2005 to January 2015 were retrospectively analyzed， and were given clinical pathological analysis combined with the review of pertinent literature. Results In this group， 3 cases were with primary lesions from the stomach， 2 cases were with primary lesions from the small intestine， 1 case was with primary lesions from the omentum majus， tumor diameter 3.5-15cm， histologic classification： spindle cell type， epithelioid cell type and mixed type， immunohistochemical： diffuse expression of tumor CD117（83.3%）， DOG-1（83.3%）and CD34（66.7%）， the liver tumor recurrence time had a certain correlation with the grading of malignant degree of primary tumor， the liver metastasis ？mitosis changed relative to primary lesions. Conclusion The histopathological characteristics of liver metastasis gastrointestinal stromal tumor is similar to the primary lesions， the diagnosis is mainly based on the diffuse positive expression of CD117 and DOG1， at present， the complete resection combined with imatinib mesylate is a main treatment measure.

[Key words] Liver； Tumor； Gastrointestinal stromal tumor； Pathology

胃肠道间质瘤（GIST）是胃肠道最常见的间叶源性肿瘤，随着基因分子生物学的发展，人们对其有了更深入的认识，c-kit基因的突变和KIT蛋白产物（CD117）的异常表达在GIST发生发展过程中起着重要作用，目前普遍学者认为GIST没有真正良恶性之分，低度恶性GIST也存在转移风险。肝脏是GIST最常见的转移部位。为探讨分析肝转移性胃肠间质瘤的临床病理特征和免疫组织化学表达及综合治疗策略，该研究搜集了2005年1月—2015年1月该院病理诊断为胃肠间质瘤并伴有术后肝转移的病例共6例进行回顾性分析其临床病理特征及免疫组织化学表达情况，并结合相关文献复习讨论其综合治疗策略，现报道如下。……