作者：马慧思，黎燕

单位：中山大学附属第一医 院病理科，广东 广州 510080

Authors: Ma Huisi, Li Yan

Unit: Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China

摘要：

目的 探讨胃血管球瘤(glomus tumor, GT)的组织病理学特征、诊断及鉴别诊断。方法 收集2010年3月至2019年12月中山大学附属第一医院诊断的7例胃GT,分析其临床病理特征、免疫表型及预后等临床诊疗资料,并复习相关文献。结果 7例胃GT,男性2例,女性5例。患者年龄26～60岁,平均年龄43岁,中位年龄45岁。4例位于胃窦,2例位于胃体,1例位于胃窦体交界处。肿瘤最大径1.4～3.0 cm,平均2.0 cm,切面灰红灰白,质中至韧。镜下见肿瘤位于胃壁固有肌层,呈多结节状生长,与周围组织边界较清,未见明确包膜。肿瘤细胞呈片状分布在血管之间或呈环状围绕在血管周围,也可以呈血管外皮瘤样排列,未见坏死,局部间质可见玻璃样变。瘤细胞形态较一致,细胞呈规则的圆形,胞质淡染透明状或淡嗜伊红色,细胞边界清晰,细胞核圆形,位于中央,部分可见小核仁,核分裂象不易见。免疫组织化学检测提示肿瘤细胞actin弥漫强阳性,syn部分阳性,CK、CD56、CgA、CD117、DOG-1、CD34、desmin均阴性,Ki-67阳性指数1%～5%,均值2%。结论 胃GT是胃少见的间叶源性肿瘤,应与上皮样细胞型胃肠道间质瘤、神经内分泌肿瘤、平滑肌瘤、副神经节瘤、孤立性纤维性肿瘤相鉴别。

关键词：血管球瘤; 胃肿瘤; 鉴别诊断; 临床病理特征

Abstract：

Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of gastric glomus tumors (GT). Methods Totally 7 cases of gastric GT were collected at the First Affiliated Hospital of Sun Yat-sen University, from March 2010 to December 2019. The clinicopathological features, immunophenotype and prognosis were retrospectively analyzed. Results Five of the 7 patients were female. Patients’age ranged from 26 to 60 years (median 45 years, mean 43 years). The most common location of the tumor was the antrum (4/7). The resected tumors were well-demarcated solid masses with sizes ranging from 1.4 to 3.0 cm (mean 2.0 cm). Microscopically, the masses were composed of abundant vascular channels with clusters of uniform and round glomus cells. The tumor cells were round or oval, and showed perivascular hemangiopericytoma-like or solid nest -like structures. Immunohistochemistry showed that actin was diffusely expressed in all the tumor cells; syn was partly expressed; the Ki-67 proliferation index ranged from 1% to 5%. Conclusions Gastric glomus tumors are unusual that should be differentiated from gastrointestinal stromal tumors, neuroendocrine tumor, leiomyoma, paraganglioma and solitary fibrous tumor. Most gastric glomus tumors in the stomach are benign.

Key Words: Glomus tumor; Gastric neoplasms; Differential diagnosis; Clinicopathological characteristics