Purpose To study the clinicopathological characteristics of synchronous gastrointestinal stromal tumor and digestive tract cancer. Methods Clinical and pathologic features were collected and analyzed in 20 0ut of 165 cases of GISTs coexisted with gastrointestinal carcinoma by retrospective studies, together with immunohistochemical staining of CD117, DOG1 etc. Results In our study,20 cases ( 12. 1％ ) of GISTs coexisted with gastrointestinal cancer were identified. There were 16 men and 4 women ( P ＜0. 05 ) aged 44 t0 79 years. with average 64. 3 years ( P ＜ 0. 05 ). 19 GISTs were located in the stomach ( 95. 0％ ) and one in the esophagus ( 5. 0％ ); 3 cases was discovered in the resection of digestive tract cancer and the others were found by pathology. The 20 CISTs sized 0. 4 t0 4. 5 cm, with average diameter of 1. 0 cm ( P ＜ 0. 01 ) and all of their microscopic features were spindle cell subtype. The risk stratification of aggressive clinical behavior was very low ( 18 cases. 90. 0％ ) and low ( 2 cases, 10. 0％ ). CD117 and DOG1 expressed in 16 ( 80. 0％ ) and 19 ( 95. 0％ ) cases, respectively, in which 4 cases were DOG1-positive and CD117-negative ( 20. 0％ ) and one was CD117-positive and DOG1-negative ( 5. 0％ ). Associated carcinomas were gastric adenocarcinoma ( 10 cases, 50. 0％ ), esophageal squamous cell carcinoma ( 9 cases. 45.0％ ). and rectal adenocarcinoma ( 1 cases. 5. 0％ ). TNM classification of gastrointestinal cancer were stage 0 ( 1 cases. 5. 0％ ), stage Ⅰ ( 3 cases, 15. 0％ ), stage Ⅱ ( 7 cases. 35. 0％ ), and stage Ⅲ ( 9cases, 45. 0％ ).Conclusions Synchronous occurrence of gastrointestinal stromal tumor and digestive tract cancer is not rare with male predominance.GISTs are preferentially located in the stomach, and gastrointestinal cancer mostly are gastric and esophageal carcinomas. Histopathology of GISTs shows spindle cell type and has a low risk of biologic behavior. Both clinicians and pathologists should put more attention,especially during operation and follow-up, on the differential diagnosis of newly detected focal GISTs to avoid their misinterpretation as metastasis from the gastrointestinal cancer. DOG1 may be useful in the differential diagnosis.%目的 探讨20例胃肠道间质瘤(gastrointestinal stromal tumor,GIST)合并消化道癌的临床病理特征.方法 回顾性研究165例GIST,对其中20例合并发生消化道癌的病例进行临床病理特征分析并行免疫组化CD117、DOG1等染色.结果 GIST合并发生消化道癌的病例占所有收集GIST病例的12.1%.20例患者中16例男性、4例女性(P＜0.05),年龄44～79岁,平均64.3岁(P＜0.05).19例GIST发生于胃(95.0%),1例发生于食管(5.0%),其中3例为消化道癌根治术中探查发现,其余均为术后病检偶然发现,直径0.4～4.5 cm,平均1.0 cm(P＜0.01).肿瘤细胞均为梭形细胞型,生物学危险度分级为极低危险度18例(90.0%)和低危险度2例(10.0%),免疫标记肿瘤细胞CD117阳性16例(80.0%),DOG1阳性19例(95.0%),其中DOG1阳性、CD117阴性4例(20.0%),CD117阳性、DOG1阴性1例(5.0%).合并发生的消化道癌中胃腺癌10例(50.0%),食管鳞癌9例(45.0%),1例为直肠腺癌(5.0%),肿瘤TNM分期0期1例(5.0%),Ⅰ期3例(15.0%),Ⅱ期7例(35.0%),Ⅲ期9例(45.0%).结论 GIST合并消化道癌并不少见.本病好发于老年男性,其中GIST多发生于胃且生物学危险度低,合并的消化道癌多为胃癌和食管癌.组织学主要为梭形细胞型,危险度分级较低.临床和病理均应重视本病的诊断,特别是在术中探查及术后随访过程中应注意与消化道癌的转移性癌结节鉴别.DOG1能帮助鉴别诊断其他胃肠道间叶源性肿瘤.
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