A Clinicopathological Study of 26 Gastrointestinal Stromal Tumors (GIST) Treated with Surgical Intervention
Kazutaka TanabeAtsuo TokukaShoichi KageyamaKojiro NakamuraShinichi SugimotoMichio TakamuraNobuhiro Ozaki
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はじめに：GISTは消化管由来の間葉系腫瘍の中では最も頻度の高い腫瘍であり，近年分子標的薬イマチニブの登場により治療戦略に大きな変化を遂げたといえる．今回，当院におけるGIST症例の臨床病理学的特徴を検討した．方法：1999年５月から2007年12月の間にsurgical interventionの対象となったGIST症例26例の検討を行った．結果：好発年齢は60歳代であり性差は認めなかった．ほとんどが胃原発であり，免疫組織学的に検査された全例でKITあるいはCD34が陽性であった．高リスク群の５年全生存率は80.0％，その他のリスク群では100％であり，統計学的な有意差は認めなかった．一方で，高リスク群の４年無再発生存率は41.7％であり，その他のリスク群の100％と比較して，有意に不良であった．結語：高リスク群におけるadjuvant療法の重要性が再確認される結果であった．To elucidate the roles of CD34-positive stromal cells and alpha-smooth muscle actin-positive stromal cells at the tumor border of skin sweat gland neoplasms, we examined expression of stromal cell markers in the tumor capsule of 19 skin sweat gland neoplasms (16 mixed tumors of the skin and three nodular hidradenomas) using monoclonal antibodies to CD34, CD31, cytokeratin 14 (CK14), alpha-smooth muscle actin (ASMA) and high molecular weight caldesmon (HCD). We regarded CD34-positive, CD31-, CK14-, ASMA- and HCD-negative stromal cells to be CD34-positive stromal cells, and ASMA-positive, HCD-, CK14-, CD34- and CD31-negative stromal cells to be ASMA-positive stromal cells. CD34-positive stromal cells were detected in the tumor capsule of all 19 of the tumors examined. In nine of the 16 mixed tumors (56%) and all of the three nodular hidradenomas, ASMA-positive stromal cells were detected at the immediate inner side of the CD34-positive stromal cell layers. These results indicate that cellular components in the tumor capsules of mixed tumors of the skin and nodular hidradenomas are CD34-positive stromal cells and ASMA-positive stromal cells, and suggest that stromal cells of these two cell types are associated with tumor capsule formation of skin sweat gland neoplasms.
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In order to understand the stromal reaction associated with colorectal neoplasms, we examined specimens from 26 patients including normal colorectal tissues (n=15), carcinoid tumors (n=12), well differentiated adenocarcinomas (n=10), and poorly differentiated adenocarcinomas (n=4), using an immunohistochemical method. Myofibroblasts and CD34-positive stromal cells were distributed in the mucosa and in the area between the submucosal and subserosal layers, respectively. However, the distribution of these cells markedly changed with the invasion of neoplasms. Namely, myofibroblasts were abundant in the invasive stroma of all colorectal neoplasms. CD34-positive stromal cells were completely absent from the invasive stroma of colorectal cancers. On the other hand, CD34-positive stromal cells were absent from four out of five carcinoid tumor cases with lesions measuring less than 2 mm in size, but were present in all seven cases of carcinoid tumors measuring more than 2 mm. Double-immunostaining identified stromal cells expressing both ASMA and CD34 in several carcinoid tumor cases. Finally, no CD34-positive stromal cells were observed in the invasive stroma of colorectal cancers. However, the distribution of these cells in carcinoid tumors may depend on the lesion size. Namely, CD34-positive stromal cells existed between neoplastic nests in large-sized carcinoid tumors. Myofibroblasts in the stroma of colorectal neoplasms may originate from CD34-positive stromal cells.
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To investigate the role of CD34 positive stromal cells, namely dendritic interstitial cells, in the desmoplastic stroma formation of malignant epithelial neoplasms the distribution of CD34 positive stromal cells was examined in human colorectal adenocarcinomas, peritumoral inflammatory tissue, and normal tissue.Forty one surgically resected human colorectal adenocarcinomas and their corresponding peritumoral inflammatory and normal tissues were examined. To distinguish CD34 positive stromal cells from vascular endothelial cells, immunostaining for both CD34 and CD31 was performed. The distribution of myofibroblasts was also analysed immunohistochemically, and double staining with CD34 and alpha smooth muscle actin (ASMA) was performed.Most of the stromal cells in the normal colorectal submucosa, muscularis propria, subserosa, and perirectal tissue were positive for CD34. In contrast, the peritumoral inflammatory tissue and the tumour stroma had no CD34 positive stromal cells. The distribution of myofibroblasts was almost the same as in the aforementioned series. No stromal cells double positive for CD34 and ASMA were detected in the peritumoral inflammatory tissues.Most stromal fibroblasts are CD34 positive stromal cells (dendritic interstitial cells). In colorectal adenocarcinomas, a lack of CD34 expression in stromal cells is associated with desmoplastic reaction.
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Objective To investigate the clinical and pathological features of gastrointestinal stromal tumors(GIST). Methods A retrospective analysis was conducted in 60 specimens which were texted by pathology department in our hospital from May 2008 to October 2013, the expression of CD117,CD34, SMA, S-100, Ki67 and Desmin were detected by using immunohistochemical SP method, statistical data was analysed by applying SPSS13.0software. Results The positive rates of CD117 and CD34 were respectively 96.7% and 91.7%. Desmin, SMA, S-100 and Ki-67-positive rate were 5.0%,26.7%, 8.3%, 26.7% respectively. Conclusions CD117 expresses in the vast majority of GIST, so it is a specific marker for the diagnosis of GIST. Joint CD34 and DOG1 detection can improve the diagnosis of GIST. While Ki-67 expression can regarded as a prognostic indicator.
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Desmin
Stromal tumor
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To investigate the role of CD34 positive stromal cells, namely dendritic interstitial cells, in gastric carcinomas, the distribution of CD34 positive stromal cells in gastric adenocarcinomas (GCs), with special reference to two histological types (diffuse (D-type) and intestinal (I-type)), was examined.In total, 55 surgically resected GCs (15 D-type and 40 I-type) and their normal tissues were examined. To distinguish CD34 positive stromal cells from vascular endothelial cells and to recognise the tumour border, immunostaining for CD34, CD31, and low molecular weight cytokeratins was performed.In the 15 D-type GCs, eight of the nine D-type GCs invading the muscularis propria and subserosa had a large number of CD34 positive stromal cells in the tumour stroma, whereas all six D-type GCs confined to the submucosa had no CD34 positive stromal cells in the tumour stroma. All of the 40 I-type GCs had no CD34 positive stromal cells, regardless of tumour depth.These results suggest that CD34 expression in stromal cells is associated with progression of D-type GCs, and that absence of expression is also seen in I-type GCs that are progressing.
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CD31
Submucosa
Stromal tumor
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Objective To investigate the expression and significance of CD117 and CD34 in gastrointestinal stromal tumors(GIST).Methods We analyzed 88 cases of GIST pathological tissue samples and used Envision two-step immunohistochemical staining to detect the expression of CD117 and CD34 in these tissues.Results CD34 and CD117 positive expression rates were 78.4% and 95.4% in GIST,respectively.They were 87.9% and 94.0% in the low malignant potential of GIST,77.8% and 96.3% in the intermediate malignant potential of GIST,67.9% and 96.5% in the high malignant potential of GIST.Conclusions CD117 and CD34 overexpress in GIST.They are useful for the diagnosis of GIST,but they can not be used as indicators to determine the risk of GIST.
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Objective To study the expression of CD34 on hematopoietic stromal cells of mice and discuss the significance.Methods Using the methods of RT PCR, blot hybrization and In Situ hybrization to analysis the expression of CD34 on ① bone marrow stromal cells of BALB/c mice in primary culture and passage culture,② hematopoietic stromal cell line NIH3T3.Results The passage cultrual bone marrow stromal cells have a high expression of CD34, secondly is NIH3T3 cells, the expression little.Conclusion The CD34 antigen was also expressed on hematopoietic the different cells may be related to the cell proliferation, cell component and the ability to support ex vivo hemtopoiesis.
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Objective To investigate the pathologic and immunohistochemical features of CD117 CD34 SMA S-100 and diagnostic criteria of gastrointestinal stromal tumors(GIST). Methods 24 cases of GIST were studied by routine and immunohistochemistry. Results The GISTS showed two bases cell types spindle and epithelioid; 21 cases, tumor cells of GIST were positivery stained for CD117. 18 cases, tumor cells of GIST were positively stained for CD34. Conclusion GIST which have no evidence of specific differentiation constitute the largest category of mesenchymal tumous of gastointestinal tract.The expression of CD117 and CD34 play an improtant role in the diagnosis of GIST.
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Stromal tumor
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Gastrointestinal stromal tumor(GIST)は問葉系腫瘍として近年注目されている.今回,直腸肛門部GISTの3症例を経験したので報告する.第1例は,平成12年に平滑筋腫の診断で切除され,平成14年に再発をきたしたたΨ再切除しGISTと診断された.初回切除標本を免疫染色したところ,smooth muscle typeのGISTであり,,再発時にはuncommitted typeと脱分化していた.第2例目は平成11年に平滑筋腫として経肛門的腫瘍切除を施行した例を免疫染色を行い,GISTと診断した例である.第3例目は,平成15年に手術を行い初回手術時にGISTと診断された例である.GISTの概念は近年確立されたもので,過去に平滑筋腫と診断されたものの中に,少なからずGISTの症例が含まれていると考えられる.したがって過去に切除された平滑筋腫はGISTを念頭に置き経過観察する必要がある.
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Several origins have been proposed for cancer-associated fibroblasts (CAFs), including resident CD34+ stromal cells/telocytes (CD34+SCs/TCs). The characteristics and arrangement of mammary CD34+SCs/TCs are well known and invasive lobular carcinoma of the breast (ILC) is one of the few malignant epithelial tumours with stromal cells that can express CD34 or αSMA, which could facilitate tracking these cells. Our objective is to assess whether tissue-resident CD34+SCs/TCs participate in the origin of CAFs in ILCs. For this purpose, using conventional and immunohistochemical procedures, we studied stromal cells in ILCs (n:42) and in normal breasts (n:6, also using electron microscopy). The results showed (a) the presence of anti-CD34+ or anti-αSMA+ stromal cells in varying proportion (from very rare in one of the markers to balanced) around nests/strands of neoplastic cells, (b) a similar arrangement and location of stromal cells in ILC to CD34+SCs/TCs in the normal breast, (c) both types of stromal cells coinciding around the same nest of neoplastic cells and (d) the coexpression of CD34 and αSMA in stromal cells in ILC. In conclusion, our findings support the hypothesis that resident CD34+SCs/TCs participate as an important source of CAFs in ILC. Further studies are required in this regard in other tumours.
Cancer-Associated Fibroblasts
Breast carcinoma
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