Gastrointestinalni stromalni tumori -- mikroskopske i imunohistohemijske karakteristike. (Serbian).

Gastrointestinal stromal tumors -- microscopic and immunihistochemical features. (English)

GASTROINTESTINAL stromal tumors; MESENCHYME tumors; GASTROINTESTINAL system; DIAGNOSIS; CANCER

Background/Aim. Gastrointestinal (GI) stromal tumors (GIST) are the most common mesenchymal tumors of GI tract. The most frequent localization is gastric (60-70%) followed by intestinal localization (20-30%). The histogenesis, classification, diagnostic criteria and biological behavior of GIST are still discussable. Gastrointestinal stromal tumors are thought to originate from interstitial pacemaker intestinal cells of Cajal. Histologic appearance of a GIST is complicated and biologic potential unpredictable. The aim of of tha study was to investigate anatomic localization , the size of the tumor, incapsulation, microscopic and immunohistochemical characteristics. Methods. The study involved 21 GIST taken by a complete resection in the period from 1994-2006. The analysed parameters were the localization, size, microscopic (mitotic index, nectosis, bleeding, invasivity) and immunohistochemical characteristics (CD117 (ckit), CD34, desmin, vimentin, smooth muscle actin and s- 100 protein expression. Results. Gastrointestinal stromal tumors (n=21) size varied from 10-150 mm were most frequently gastric localised with predominance of malignant tumors (85.72%). Most GIST were comprised of a uniform spindle cell population, but some were dominated by epitheloid cells. Eosinophilic cells stained CD117, CD34 and vimentin positively, were usually arranged in fascicles with the presence of skeinoid fibers. Positive correlation of biologic potential and tumor size, haemorrhagia and mitotic index were found, so as negative correlation of biologic potential and incapsulation. Conclusion. The above results, a specially localization, tumor size, mitotic index, CD117, CD34 and vimentin positivity, may be helpful for setting of a widespread criteria for diagnostic and differential diagnosis of GIST and their use in practice and therapy. [ABSTRACT FROM AUTHOR]

Uvod/Cilj. Gastrointestinalni stromalni tumori (GIST) najčešći su mezenhimski tumori u gastrointestinalnom (GI) traktu. Najčešće su lokalizovani u želucu (60-70%), zatim u tankom crevu (20-30%) i debelom crevu i rektumu (5-10%). Histološko poreklo, klasifikacija, dijagnostički kriterijumi i njihov biološki potencijal još uvek su sporni. Danas preovladava stav da GIST vode poreklo od Cajalovih ćelija (pacemaker ćelija GI trakta). Histološka slika GIST je složena, a biološki potencijal nepredvidiv. Cilj ovog rada bio je da se ispitaju anatomska lokalizacija, veličina i inkapsulisanost tumora kao i njegove mikroskopske i imunohistohemijske karakteristike. Metode. Ispitivanjem su obuhvaćeni GIST (n=21) dobijeni kompletnom resekcijom, u periodu od 1994. do 2006. godine. Analizirane su lokalizacija, veličina, mikroskopske (mitotski indeks, nekroza, krvarenje, invazivnost) i imunohistohemijske osobine (ispitivani su CD117 (c-kit), CD34, dezmin, vimentin, aktin glatkog tkiva i S100 protein ekspresija). Rezultati. U želucu su najčešće bili lokalizovani GIST veličine 10-15 mm, predominantno visokorizični (85,7%). Histološki, najzastupljeniji bili su GIST vretenastog, ređe epiteloidnog tipa. Tumor su činile uniformne eozinofilne ćelije pozitivne ekspresije na CD117, CD34 i vimentin, fascikularno ili vrtložno raspoređene, uz prisustvo skenoidnih telašaca. Proučavani patohistološki kriterijumi pokazali su da postoji pozitivna korelacija između biološkog potencijala i veličine tumora, nekroze, krvarenja i mitotske aktivnosti ćelija, odnosno negativna korelacija između inkapsulisanosti i biološkog potencijala tumora. Zaključak. Anatomska lokalizacija, veličina tumora i mitotski indeks, CD117, CD34 i vimentin pozitivnost, kao i infiltracija okolnih struktura i prisustvo metastaza mogu pomoći u određivanju kriterijuma za dijagnozu i diferencijaciju GIST. [ABSTRACT FROM AUTHOR]

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