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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ»ɩɥ.ɀɨɜɬɧɟɜɚ, 14, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49000, ɍɤɪɚʀɧɚ
SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine» Zhovtneva sq., 14, Dnipropetrovsk, 49000, Ukraine
e-mail: skorikvr@gmail.com
Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɝɚɫɬɪɨɿɧɬɟɫɬɢɧɚɥɶɧɿ ɫɬɪɨɦɚɥɶɧɿ ɩɭɯɥɢɧɢ,ɞɢɮɟɪɟɧɰɿɣɧɚ ɞɿɚɝɧɨɫɬɢɤɚ,ɿɦɭɧɨɝɿɫɬɨɯɿɦɿɱɧɟ
ɞɨɫɥɿɞɠɟɧɧɹ, CD117, DOG1, CD34
Key words: gastrointestinal stromal tumors, differential diagnosis, immunohistochemical study, CD117, DOG1, CD34
Ɋɟɮɟɪɚɬ. Ƚɚɫɬɪɨɢɧɬɟɫɬɢɧɚɥɶɧɚɹ ɫɬɪɨɦɚɥɶɧɚɹ ɨɩɭɯɨɥɶ ɛɨɥɶɲɢɯ ɪɚɡɦɟɪɨɜ ɷɤɫɬɪɚɝɚɫɬɪɨɢɧɬɟɫɬɢɧɚɥɶɧɨɣ
ɥɨɤɚɥɢɡɚɰɢɢ ɫ ɪɚɡɧɵɦɢ ɦɨɪɮɨɥɨɝɢɱɟɫɤɢɦɢ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦɢ.ɒɩɨɧɶɤɚ ɂ.ɋ., Ƚɪɢɰɟɧɤɨ ɉ.Ⱥ.,ɋɤɨɪɢɤ ȼ.Ɋ.
ɉɪɨɛɥɟɦɚɬɢɤɚ ɬɨɱɧɨɣ ɜɟɪɢɮɢɤɚɰɢɢ ɞɢɚɝɧɨɡɚ ɝɚɫɬɪɨɢɧɬɟɫɬɢɧɚɥɶɧɨɣ ɫɬɪɨɦɚɥɶɧɨɣ ɨɩɭɯɨɥɢ ɫɟɝɨɞɧɹ ɹɜɥɹɟɬɫɹ ɚɤɬɭɚɥɶɧɨɣ ɩɨ ɦɧɨɝɢɦ ɩɪɢɱɢɧɚɦ. Ɍɚɤ, ɝɢɫɬɨɥɨɝɢɱɟɫɤɭɸ ɞɢɚɝɧɨɫɬɢɤɭ ɭɫɥɨɠɧɹɟɬ ɧɚɥɢɱɢɟ ɦɨɪɮɨɥɨɝɢɱɟɫɤɨɣ
ɩɨɞɨɛɧɨɫɬɢ ɫ ɞɪɭɝɢɦɢ ɦɟɡɟɧɯɢɦɚɥɶɧɵɦɢ ɧɨɜɨɨɛɪɚɡɨɜɚɧɢɹɦɢ ɠɟɥɭɞɨɱɧɨ-ɤɢɲɟɱɧɨɝɨ ɬɪɚɤɬɚ,ɚ ɬɚɤɠɟ ɨɩɪɟɞɟ
-ɥɟɧɢɟ ɝɢɫɬɨɥɨɝɢɱɟɫɤɢ ɪɚɡɥɢɱɧɵɯ ɡɨɧ ɜ ɩɪɟɞɟɥɚɯ ɨɞɧɨɣ ɢɫɫɥɟɞɭɟɦɨɣ ɨɩɭɯɨɥɢ.Ɇɵ ɩɪɟɞɫɬɚɜɥɹɟɦ ɫɢɬɭɚɰɢɸ ɫ ɜɵ
-ɲɟɭɤɚɡɚɧɧɨɣ ɩɪɨɛɥɟɦɚɬɢɤɨɣ: ɩɪɨɜɟɞɟɧɢɟ ɞɢɮɮɟɪɟɧɰɢɚɥɶɧɨɣ ɞɢɚɝɧɨɫɬɢɤɢ ɜɤɥɸɱɚɟɬ ɚɧɚɥɢɡ ɦɨɪɮɨɥɨɝɢɱɟɫɤɢɯ
ɤɪɢɬɟɪɢɟɜ ɢ ɩɨɥɭɱɟɧɧɵɯ ɢɦɦɭɧɨɝɢɫɬɨɯɢɦɢɱɟɫɤɢɯ ɪɟɚɤɰɢɣ. ɉɪɢ ɫɪɚɜɧɟɧɢɢ ɢɦɦɭɧɨɮɟɧɨɬɢɩɚ ɝɢɫɬɨɥɨɝɢɱɟɫɤɢ
ɪɚɡɥɢɱɧɵɯ ɡɨɧ ɩɪɢɧɰɢɩɢɚɥɶɧɨɣ ɪɚɡɧɢɰɵ ɧɟ ɜɵɹɜɥɟɧɨ.
Abstract. Gastrointestinal stromal tumor of large size, extragastrointestinal localization and different morphological features. Shpon’ka I.S., Grycenko P.O., Skoryk V.R. The problems of accurate verification of the gastrointestinal stromal tumor are relevant today for many reasons. Thus, the histological diagnosis is complicated by the morphological similarity of other gastrointestinal tract mesenchymal neoplasms and by histologicaly different zones within the same investigation. We present the situation with the above issues: the differential diagnosis includes an analysis of morphological criteria and received immunohisto-chemical reactions. Between immunophenotypes of histologicaly different zones principal difference is not revealed.
ɋɟɪɟɞ ɞɨɛɪɨɹɤɿɫɧɢɯ ɬɚ ɡɥɨɹɤɿɫɧɢɯ ɦ’ɹɤɨɬɤɚ
-ɧɢɧɧɢɯ ɩɭɯɥɢɧ ɱɟɪɟɜɧɨʀ ɩɨɪɨɠɧɢɧɢ ɧɚɣɩɨɲɢ
-ɪɟɧɿɲɢɦɢ ɜɜɚɠɚɸɬɶɫɹ ɥɟɣɨɦɿɨɦɢ ɬɚ ɥɿɩɨɫɚɪɤɨɦɢ ɜɿɞɩɨɜɿɞɧɨ [7, 3]. ɉɪɨɬɟ ɭ ɬɪɚɜɧɿɣ ɬɪɭɛɰɿ ɧɚ
ɩɟɪɲɨɦɭ ɦɿɫɰɿ ɡɚ ɱɚɫɬɨɬɨɸ ɜɢɧɢɤɧɟɧɧɹ ɫɟɪɟɞ ɦɟɡɟɧɯɿɦɚɥɶɧɢɯ ɧɨɜɨɭɬɜɨɪɟɧɶ ɽ ɝɚɫɬɪɨɿɧɬɟɫɬɢ
-ɧɚɥɶɧɿ ɫɬɪɨɦɚɥɶɧɿ ɩɭɯɥɢɧɢ (Ƚȱɋɉ), ɹɤɿ ɦɨɠɭɬɶ
ɪɨɡɜɢɜɚɬɢɫɹ ɬɚɤɨɠ ɿ ɟɤɫɬɪɚɝɚɫɬɪɨɿɧɬɟɫɬɢɧɚɥɶɧɨ
(ɦɟɧɲɟ 10% ɜɿɞ ɡɚɝɚɥɶɧɨʀ ɤɿɥɶɤɨɫɬɿ) [5, 6]. ȼɪɚ
-ɯɨɜɭɸɱɢ ɧɚɹɜɧɿɫɬɶ ɤɥɿɧɿɱɧɢɯ ɬɚ ɦɨɪɮɨɥɨɝɿɱɧɢɯ ɤɪɢɬɟɪɿʀɜ ɩɨɞɿɛɧɨɫɬɿ ɜɫɿɯ ɜɢɳɟɡɚɡɧɚɱɟɧɢɯ ɧɨ
-ɜɨɭɬɜɨɪɟɧɶ ɬɚ ɩɪɢɧɰɢɩɨɜɨ ɪɿɡɧɢɯ ɩɿɞɯɨɞɿɜ ɞɨ ʀɯ ɥɿɤɭɜɚɧɧɹ ɬɚ ɩɪɨɝɧɨɡɿɜ ɠɢɬɬɹ ɧɟɨɛɯɿɞɧɟ ɩɪɨ
-ɜɟɞɟɧɧɹ ɪɟɬɟɥɶɧɨʀ ɞɢɮɟɪɟɧɰɿɣɧɨʀ ɞɿɚɝɧɨɫɬɢɤɢ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɿɦɭɧɨɝɿɫɬɨɯɿɦɿɱɧɨɝɨ ɞɨɫɥɿɞɠɟɧ
-ɧɹ. ɉɪɨɬɟ ɜɟɪɢɮɿɤɚɰɿɸ ɞɿɚɝɧɨɡɭ ɦɨɠɟ ɭɫ
-ɤɥɚɞɧɸɜɚɬɢ ɧɚɹɜɧɿɫɬɶ ɜ ɨɞɧɿɣ ɩɭɯɥɢɧɿ ɡɨɧ ɡ ɪɿɡɧɢɦɢ ɦɨɪɮɨɥɨɝɿɱɧɢɦɢ ɜɚɪɿɚɧɬɚɦɢ ɬɚ ɯɚɪɚɤɬɟ
-ɪɨɦ ɟɤɫɩɪɟɫɿʀ ɨɞɧɨɝɨ ɣ ɬɨɝɨ ɠ ɿɦɭɧɨɝɿɫɬɨ
-ɯɿɦɿɱɧɨɝɨ ɦɚɪɤɟɪɭ [2]. ɍ ɫɬɚɬɬɿ ɞɨɩɨɜɿɞɚɽɦɨ
ɥɢɧɢ ɡɚɨɱɟɪɟɜɢɧɧɨɝɨ ɩɪɨɫɬɨɪɭ ɡ ɧɚɹɜɧɿɫɬɸ ɡɨɧ ɡ ɪɿɡɧɨɸ ɦɨɪɮɨɥɨɝɿɱɧɨɸ ɛɭɞɨɜɨɸ ɬɚ ɫɯɨɠɨɫɬɿ ɡ ɿɧɲɢɦɢ ɦɟɡɟɧɯɿɦɚɥɶɧɢɦɢ ɧɨɜɨɭɬɜɨɪɟɧɧɹɦɢ
(ɥɟɣɨɦɿɨɦɨɸ,ɥɿɩɨɫɚɪɤɨɦɨɸ).
ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ
Ⱦɨ Ⱦɿɚɝɧɨɫɬɢɱɧɨɝɨ ɰɟɧɬɪɭ ɦɟɞɢɱɧɨʀ ɚɤɚɞɟɦɿʀ
(ɦ. Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ) ɧɚɞɿɣɲɨɜ ɨɩɟɪɚɰɿɣɧɢɣ
ɦɚɬɟɪɿɚɥ ɩɚɰɿɽɧɬɚ 66 ɪɨɤɿɜ ɜɢɞɚɥɟɧɨʀ ɪɟɰɢɞɢ
-ɜɭɸɱɨʀ ɝɿɝɚɧɬɫɶɤɨʀ ɩɭɯɥɢɧɢ ɡɚɨɱɟɪɟɜɢɧɧɨɝɨ ɩɪɨɫɬɨɪɭ. ȼɩɟɪɲɟ ɞɨ ɥɿɤɚɪɹ ɯɜɨɪɢɣ ɡɜɟɪɧɭɜɫɹ
ɩɿɜɬɨɪɚ ɪɨɤɢ ɬɨɦɭ ɡɿ ɫɤɚɪɝɚɦɢ ɧɚ ɧɨɜɨɭɬɜɨɪɟɧɧɹ,
ɳɨ ɜɿɡɭɚɥɶɧɨ ɜɢɡɧɚɱɚɥɨɫɶ ɱɟɪɟɡ ɲɤɿɪɭ ɩɟɪɟɞɧɶɨʀ ɱɟɪɟɜɧɨʀ ɫɬɿɧɤɢ, ɡɚɝɚɥɶɧɭ ɫɥɚɛɤɿɫɬɶ, ɜɬɪɚɬɭ ɜɚɝɢ.
Ɂɚ ɞɚɧɢɦɢ ɤɨɦɩ`ɸɬɟɪɧɨʀ ɬɨɦɨɝɪɚɦɢ (ɄɌ):
ɧɨɜɨɭɬɜɨɪɟɧɧɹ ɡɚɨɱɟɪɟɜɢɧɧɨɝɨ ɩɪɨɫɬɨɪɭ ɪɨɡɦɿ
-ɪɚɦɢ 14,9ɯ11,2ɯ14,2ɫɦ ɡ ɱɿɬɤɢɦɢ ɪɿɜɧɢɦɢ ɤɨɧɬɭ
-ɪɚɦɢ ɬɚ ɩɨɪɨɠɧɢɧɚɦɢ ɪɨɡɩɚɞɭ, ɳɨ ɳɿɥɶɧɨ
ɩɪɢɥɹɝɚɽ ɞɨ ɥɿɜɨʀ ɧɢɪɤɢ. ɉɿɫɥɹ ɜɢɞɚɥɟɧɧɹ ɩɭɯ
-ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
ɜɿɡɭɚɥɿɡɭɽɬɶɫɹ ɧɨɜɨɭɬɜɨɪɟɧɧɹ ɪɨɡɦɿɪɨɦ
8,2ɯ6,3ɯ11,2 ɫɦ ɡ ɬɨɧɤɨɸ ɫɬɿɧɤɨɸ, ɳɨ ɳɿɥɶɧɨ
ɩɪɢɥɹɝɚɽ ɞɨ ɤɥɭɛɨɜɨʀ ɤɢɲɤɢ. ɉɿɫɥɹ ɞɪɭɝɨʀ ɨɩɟ
-ɪɚɰɿʀ ɝɿɫɬɨɥɨɝɿɱɧɚ ɤɚɪɬɢɧɚ ɜɿɞɩɨɜɿɞɚɽ ɥɿɩɨ
-ɫɚɪɤɨɦɿ.Ɋɟɝɿɨɧɚɪɧɢɯ ɬɚ ɜɿɞɞɚɥɟɧɢɯ ɦɟɬɚɫɬɚɡɿɜ ɧɟ
ɜɢɹɜɥɟɧɨ. Ɂ ɦɟɬɨɸ ɜɟɪɢɮɿɤɚɰɿʀ ɦɨɪɮɨɥɨɝɿɱɧɨɝɨ
ɞɿɚɝɧɨɡɭ ɦɚɬɟɪɿɚɥ ɪɟɰɢɞɢɜɭ ɧɨɜɨɭɬɜɨɪɟɧɧɹ ɛɭɥɨ ɧɚɩɪɚɜɥɟɧɨ ɧɚ ɿɦɭɧɨɝɿɫɬɨɯɿɦɿɱɧɟ ɞɨɫɥɿɞɠɟɧɧɹ.
ɉɿɞ ɱɚɫ ɦɨɪɮɨɥɨɝɿɱɧɨɝɨ ɜɢɜɱɟɧɧɹ ɝɿɫɬɨɥɨ
-ɝɿɱɧɢɯ ɩɪɟɩɚɪɚɬɿɜ, ɡɚɛɚɪɜɥɟɧɢɯ ɡɚ ɫɬɚɧɞɚɪɬɧɨɸ
ɦɟɬɨɞɢɤɨɸ (ɛɚɪɜɧɢɤɢ – ɝɟɦɚɬɨɤɫɢɥɿɧ, ɟɨɡɢɧ)
ɛɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ,ɳɨ ɩɭɯɥɢɧɚ ɦɚɥɚ ɨɡɧɚɤɢ ɥɟɣɨ
-ɦɿɨɦɢ ɬɚ ɥɿɩɨɫɚɪɤɨɦɢ.Ɍɨɦɭ ɞɨ ɩɟɪɜɢɧɧɨʀ ɩɚɧɟɥɿ
ɿɦɭɧɨɝɿɫɬɨɯɿɦɿɱɧɢɯ ɦɚɪɤɟɪɿɜ ɭɜɿɣɲɥɢ ɩɟɪɜɢɧɧɿ ɚɧɬɢɬɿɥɚ ɜɿɦɟɧɬɢɧ (ɤɥɨɧ Sp20, ɪɨɡɜɟɞɟɧɧɹ (ɪ.) 1:200), SMA (ɤɥɨɧ ab-1, ɪ. 1:500), MSA Ab-4 (ɤɥɨɧ HHF-35, ɪ.1:100) S100 Ab-1 (ɤɥɨɧ 4C4.9, ɪ. 1:150), CD34 (ɤɥɨɧ ab-1, ɪ. 1:500), CD117 (ɤɥɨɧ ab-1, ɪ. 1:200), DOG1 (ɤɥɨɧ Sp21, ɪ.1:100), Ki-67(ɤɥɨɧ sp6, ɪ.1:150). Ɍɚɤɨɠ ɦɢ ɜɿɞɿɛɪɚɥɢ 2 ɡɪɚɡ
-ɤɢ ɡ ɪɿɡɧɨɸ ɦɨɪɮɨɥɨɝɿɱɧɨɸ ɛɭɞɨɜɨɸ ɞɥɹ ɨɰɿɧ-ɤɢ ɧɚɹɜɧɨɫɬɿ ɡɦɿɧ ɯɚɪɚɤɬɟɪɭ ɟɤɫɩɪɟɫɿʀ ɿɦɭɧɨɝɿɫɬɨ
-ɯɿɦɿɱɧɢɯ ɦɚɪɤɟɪɿɜ.
ɊȿɁɍɅɖɌȺɌɂ ɌȺ ȱɏ ɈȻȽɈȼɈɊȿɇɇə
ȼ ɨɞɧɿɣ ɩɭɯɥɢɧɿ ɦɨɠɭɬɶ ɡɭɫɬɪɿɱɚɬɢɫɹ ɜɢɩɚɞɤɢ ɡ ɪɿɡɧɨɸ ɦɨɪɮɨɥɨɝɿɱɧɨɸ ɛɭɞɨɜɨɸ. ȼ ɞɟɹɤɢɯ ɩɨ
-ɥɹɯ ɡɨɪɭ ɞɨɫɥɿɞɠɭɜɚɧɚ ɩɭɯɥɢɧɚ ɭɬɜɨɪɟɧɚ ɨɤ
-ɪɭɝɥɢɦɢ ɬɚ ɞɟɳɨ ɜɢɬɹɝɧɭɬɢɦɢ ɤɥɿɬɢɧɚɦɢ, ɹɤɿ
ɦɚɸɬɶ ɨɤɪɭɝɥɨ-ɜɢɞɨɜɠɟɧɿ ɹɞɪɚ ɡ ɪɹɫɧɨɸ ɫɜɿɬɥɨɸ
ɰɢɬɨɩɥɚɡɦɨɸ ɬɚ ɨɪɝɚɧɿɡɨɜɚɧɿ ɭ ɝɪɭɩɢ ɬɚ ɝɧɿɡɞɚ
(ɪɢɫ. 1). Ɍɚɤɚ ɝɿɫɬɨɥɨɝɿɱɧɚ ɤɚɪɬɢɧɚ ɩɨɬɪɚɩɥɹɽ ɩɿɞ
ɨɩɢɫ ɟɩɿɬɟɥɿɨʀɞɧɨɝɨ ɜɚɪɿɚɧɬɭ Ƚȱɋɉ. ɇɚ ɤɨɪɢɫɬɶ
ɡɥɨɹɤɿɫɧɨɫɬɿ ɩɪɨɰɟɫɭ ɜ ɰɶɨɦɭ ɜɢɩɚɞɤɭ ɫɜɿɞɱɚɬɶ ɧɚɹɜɧɿ 8-9 ɦɿɬɨɬɢɱɧɢɯ ɮɿɝɭɪ ɧɚ 50 ɩɨɥɿɜ ɡɨɪɭ ɬɚ
ɩɨɦɿɪɧɨ ɜɢɪɚɠɟɧɢɣ ɩɨɥɿɦɨɪɮɿɡɦ,ɳɨ ɚɪɝɭɦɟɧɬɭɽ
ɩɪɨɜɟɞɟɧɧɹ ɞɢɮɟɪɟɧɰɿɣɧɨʀ ɞɿɚɝɧɨɫɬɢɤɢ ɿ ɡ ɫɚɪɤɨ
-ɦɚɦɢ. əɞɪɚ ɝɿɩɟɪɯɪɨɦɧɿ ɡ, ɩɟɪɟɜɚɠɧɨ, ɤɨɧɞɟɧ
-ɫɨɜɚɧɢɦ ɝɪɚɧɭɥɹɪɧɢɦ ɯɪɨɦɚɬɢɧɨɦ, ɜɿɞɪɿɡɧɹɸɬɶ
-ɫɹ ɨɞɧɟ ɜɿɞ ɨɞɧɨɝɨ ɡɚ ɮɨɪɦɨɸ ɬɚ ɪɨɡɦɿɪɨɦ,
ɹɞɟɪɰɹ ɧɟ ɜɢɪɚɠɟɧɿ. Ɍɚɤɿ ɤɥɿɬɢɧɢ ɧɚɝɚɞɭɸɬɶ
ɥɿɩɨɛɥɚɫɬɢ, ɞɥɹ ɹɤɢɯ ɯɚɪɚɤɬɟɪɧɨ ɨɞɧɟ ɱɢ ɞɜɚ
ɨɤɪɭɝɥɢɯ ɱɢ ɮɟɫɬɨɧɱɚɬɢɯ, ɝɿɩɟɪɯɪɨɦɧɢɯ, ɪɨɡ
-ɬɚɲɨɜɚɧɢɯ ɩɨ ɰɟɧɬɪɭ ɱɢ ɧɚ ɩɟɪɢɮɟɪɿʀ ɹɞɪɚ ɬɚ ɩɟɪɟɜɚɝɚ ɹɞɟɪɧɨ-ɰɢɬɨɩɥɚɡɦɚɬɢɱɧɨɝɨ ɫɩɿɜɜɿɞɧɨ
-ɲɟɧɧɹ ɜ ɛɿɤ ɰɢɬɨɩɥɚɡɦɢ ɡɚ ɪɚɯɭɧɨɤ ɧɚɹɜɧɨɫɬɿ ɡɧɚɱɧɨʀ ɤɿɥɶɤɨɫɬɿ ɜɧɭɬɪɿɲɧɶɨɤɥɿɬɢɧɧɢɯ ɤɪɚɩɟɥɶ ɠɢɪɭ. ɉɪɨɬɟ ɞɥɹ ɥɿɩɨɫɚɪɤɨɦɢ ɯɚɪɚɤɬɟɪɧɚ ɧɚɹɜ
-ɧɿɫɬɶ ɪɨɡɫɿɹɧɢɯ ɩɨɥɿɦɨɪɮɧɢɯ, ɱɚɫɬɨ ɛɚɝɚɬɨ
-ɹɞɟɪɧɢɯ, ɫɬɪɨɦɚɥɶɧɢɯ ɤɥɿɬɢɧ («bizarre» ɤɥɿɬɢɧ)
ɫɟɪɟɞ ɪɿɡɧɨɝɨ ɫɬɭɩɟɧɹ ɜɢɪɚɡɧɨɫɬɿ ɫɩɨɥɭɱɧɨ
-ɬɤɚɧɢɧɧɢɯ ɫɟɩɬ ɡ ɝɿɩɟɪɯɪɨɦɧɢɦɢ ɜɟɪɟɬɟɧɨɩɨ
-ɞɿɛɧɢɦɢ ɤɥɿɬɢɧɚɦɢ. ɏɨɱɚ ɞɥɹ ɟɩɿɬɟɥɿɨʀɞɧɨɝɨ
ɜɚɪɿɚɧɬɭ Ƚȱɋɉ ɬɚɤɨɠ ɯɚɪɚɤɬɟɪɧɚ ɧɚɹɜɧɿɫɬɶ ɳɿɥɶɧɨɝɨ ɤɨɥɚɝɟɧɭ ɦɿɠ ɩɭɯɥɢɧɧɢɦɢ ɨɫɟɪɟɞɤɚɦɢ.
ɐɿ ɞɚɧɿ ɧɟ ɞɨɡɜɨɥɹɸɬɶ ɝɿɫɬɨɥɨɝɿɱɧɨ ɞɨɫɬɨɜɿɪɧɨ ɜɢɡɧɚɱɢɬɢɫɶ ɡ ɞɿɚɝɧɨɡɨɦ.
Ɋɢɫ. 1. Ƚȱɋɉ,ɟɩɿɬɟɥɿɨʀɞɧɢɣ ɜɚɪɿɚɧɬ (ɤɥɿɬɢɧɢ ɬɢɩɭ ɥɿɩɨɛɥɚɫɬɿɜ).
ɜɚɪɿɚɧɬɭ Ƚȱɋɉ (ɪɢɫ. 2), ɦɚɸɬɶ ɫɯɨɠɿ ɦɨɪɮɨ
-ɥɨɝɿɱɧɿ ɨɡɧɚɤɢ ɡ ɩɭɯɥɢɧɚɦɢ ɝɥɚɞɤɨɦ’ɹɡɨɜɨɝɨ
ɩɨɯɨɞɠɟɧɧɹ: ɜɢɬɹɝɧɭɬɿ ɤɥɿɬɢɧɢ ɡ ɪɹɫɧɨɸ ɫɜɿɬɥɨ
-ɡɚɛɚɪɜɥɟɧɨɸ ɰɢɬɨɩɥɚɡɦɨɸ ɬɚ ɨɜɨʀɞɧɢɦ ɰɟɧɬɪɚɥɶɧɨ ɪɨɡɬɚɲɨɜɚɧɢɦ ɹɞɪɨɦ, ɹɤɿ ɭɬɜɨɪɸɸɬɶ
ɩɟɪɟɫɿɱɧɿ ɩɭɱɤɢ. ɉɪɨɬɟ ɞɥɹ ɥɟɣɨɦɿɨɦ ɬɚ ɥɟɣɨ
-ɦɿɨɫɚɪɤɨɦ ɛɿɥɶɲ ɯɚɪɚɤɬɟɪɧɿ ɤɥɿɬɢɧɢ ɡ ɜɢɞɨɜ
-ɠɟɧɢɦ ɹɞɪɨɦ ɡ ɬɭɩɢɦ ɤɿɧɰɟɦ («blunt-ended») ɱɢ ɭ
ɮɨɪɦɿ ɫɢɝɚɪɢ,ɬɨɞɿ ɹɤ ɭ ɞɨɫɥɿɞɠɭɜɚɧɨɦɭ ɜɢɩɚɞɤɭ
ɞɥɹ Ƚȱɋɉ. Ⱦɥɹ ɥɟɣɨɦɿɨɦ ɬɚ ɜɢɫɨɤɨɞɢɮɟ
-ɪɟɧɰɿɣɨɜɚɧɢɯ ɫɚɪɤɨɦ ɯɚɪɚɤɬɟɪɧɿ ɞɨɜɝɿ ɩɪɚɜɢɥɶɧɨ ɨɪɿɽɧɬɨɜɚɧɿ ɩɭɱɤɢ, ɳɨ ɩɟɪɟɯɪɟɳɭɸɬɶɫɹ, ɩɟɪɟ
-ɜɚɠɧɨ, ɩɿɞ ɤɭɬɨɦ 90ƕ, ɬɨɞɿ ɹɤ ɩɭɯɥɢɧɿ ɤɥɿɬɢɧɢ
Ƚȱɋɉ ɭɬɜɨɪɸɸɬɶ ɤɨɪɨɬɤɿ ɧɟɱɿɬɤɨ ɜɢɡɧɚɱɟɧɿ ɜ ɧɚɩɪɚɜɥɟɧɧɿ ɡɚɜɢɬɤɢ. ɉɪɨɬɟ ɜ ɬɚɤɨɦɭ ɜɢɩɚɞɤɭ
ɰɟɣ ɤɪɢɬɟɪɿɣ ɫɜɿɞɱɢɬɶ ɭ ɛɿɤ ɜɟɪɢɮɿɤɚɰɿʀ ɝɥɚɞɤɨ
-ɦ’ɹɡɨɜɨʀ ɩɭɯɥɢɧɢ.
Ɋɢɫ. 2. Ƚȱɋɉ,ɜɟɪɟɬɟɧɨɩɨɞɿɛɧɢɣ ɜɚɪɿɚɧɬ ɡ ɩɨɦɿɪɧɨ ɜɢɪɚɠɟɧɢɦ ɩɨɥɿɦɨɪɮɿɡɦɨɦ,ɮɿɝɭɪɚɦɢ ɦɿɬɨɡɭ.
Ɂɚɛɚɪɜɥɟɧɧɹ ɝɟɦɚɬɨɤɫɢɥɿɧɨɦ Ɇɚɣɽɪɚ.ɟɨɡɢɧɨɦ,ɯ400
Ɍɚɤɨɠ ɫɯɨɠɭ ɦɿɤɪɨɫɤɨɩɿɱɧɭ ɤɚɪɬɢɧɭ ɦɨɠɟ ɦɚɬɢ ɞɟɞɢɮɟɪɟɰɿɣɨɜɚɧɚ ɥɿɩɨɫɚɪɤɨɦɚ, ɳɨ ɽ ɧɚɣ
-ɱɚɫɬɿɲɨɸ ɡɥɨɹɤɿɫɧɨɸ ɦɟɡɟɧɯɿɦɚɥɶɧɨɸ ɩɭɯɥɢɧɨɸ ɡɚɨɱɟɪɟɜɢɧɧɨɝɨ ɩɪɨɫɬɨɪɭ ɫɟɪɟɞ ɜɟɪɟɬɟɧɨ
-ɩɨɞɿɛɧɢɯ ɬɚ ɩɥɟɨɦɨɪɮɧɢɯ ɫɚɪɤɨɦ [8]. ɏɨɱɚ ɞɥɹ
ɰɶɨɝɨ ɬɢɩɭ ɧɨɜɨɭɬɜɨɪɟɧɶ ɯɚɪɚɤɬɟɪɧɚ ɧɚɹɜɧɿɫɬɶ ɞɜɨɯ ɱɿɬɤɨ ɜɿɞɨɤɪɟɦɥɟɧɢɯ ɤɨɦɩɨɧɟɧɬɿɜ: ɜɢɫɨ
-ɤɨɞɢɮɟɪɟɧɰɿɣɨɜɚɧɨʀ ɥɿɩɨɫɚɪɤɨɦɢ, ɭɬɜɨɪɟɧɨʀ ɡ
ɜɿɞɧɨɫɧɨ ɡɪɿɥɢɯ ɨɞɧɨɜɚɤɭɨɥɶɧɢɯ ɚɞɢɩɨɰɢɬɿɜ ɪɿɡɧɨɝɨ ɪɨɡɦɿɪɭ ɬɚ ɮɨɪɦɢ, ɬɚ ɡɥɨɹɤɿɫɧɨɝɨ ɧɟɥɿ
-ɩɨɝɟɧɧɨɝɨ ɤɨɦɩɨɧɟɧɬɭ, ɭɬɜɨɪɟɧɨɝɨ ɜɟɪɟɬɟɧɨ
-ɩɨɞɿɛɧɢɦɢ ɤɥɿɬɢɧɚɦɢ. ɉɪɨɬɟ ɽ ɜɢɩɚɞɤɢ, ɤɨɥɢ
ɥɿɩɨɝɟɧɧɚ ɱɚɫɬɢɧɚ ɩɪɨɩɭɫɤɚɽɬɶɫɹ, ɬɨɦɭ ɳɨ ɧɟ
ɪɨɡɰɿɧɸɽɬɶɫɹ ɹɤ ɡɥɨɹɤɿɫɧɚ. ɓɨɞɨ ɧɟɥɿɩɨɝɟɧɧɨɝɨ
ɤɨɦɩɨɧɟɧɬɭ: ɜɿɧ ɧɟ ɦɚɽ ɫɩɟɰɢɮɿɱɧɨɝɨ ɝɿɫɬɨ
-ɟɤɫɩɪɟɫɭɜɚɬɢ ɦɚɪɤɟɪ ɦɿɨɮɿɛɪɨɛɥɚɫɬɢɱɧɨɝɨ ɩɨ
-ɯɨɞɠɟɧɧɹ – ɞɟɫɦɿɧ. Ɇɨɪɮɨɥɨɝɿɱɧɭ ɫɯɨɠɿɫɬɶ ɡ
Ƚȱɋɉ ɜɢɹɜɥɹɽ ɧɚɹɜɧɿɫɬɶ ɜɢɬɹɝɧɭɬɢɯ ɤɥɿɬɢɧ ɡ ɨɜɚɥɶɧɢɦ ɹɞɪɨɦ,ɳɨ ɮɨɪɦɭɸɬɶ ɫɬɪɭɤɬɭɪɢ, ɫɯɨɠɿ
ɧɚ ɩɭɱɤɢ ɬɚ «ɡɚɜɢɯɪɟɧɧɹ»,ɜɢɡɧɚɱɟɧɧɹ ɧɟɜɟɥɢɤɢɯ
ɜɚɤɭɨɥɟɣ ɛɿɥɹ ɹɞɪɚ. ɉɪɨɬɟ ɨɫɬɚɧɧɿ ɽ ɨɡɧɚɤɨɸ
ɞɟɝɟɧɟɪɚɬɢɜɧɢɯ ɬɚ ɚɬɪɨɮɿɱɧɢɯ ɡɦɿɧ ɩɭɯɥɢɧɧɨʀ ɤɥɿɬɿɧɢ, ɚ ɧɟ ɧɚɫɥɿɞɤɨɦ ɟɬɚɩɿɜ ɮɿɤɫɚɰɿʀ ɨɩɟɪɚ
-ɰɿɣɧɨɝɨ ɦɚɬɟɪɿɚɥɭ,ɳɨ ɯɚɪɚɤɬɟɪɧɨ ɞɥɹ Ƚȱɋɉ.
ȱɦɭɧɨɝɿɫɬɨɯɿɦɿɱɧɚ ɩɚɧɟɥɶ ɦɚɪɤɟɪɿɜ ɜɤɥɸɱɚɥɚ:
ɜɿɦɟɧɬɢɧ, CD117, CD34, DOG1, S100, Į-SMA, MSA, Ki-67. Ⱦɨɫɥɿɞɠɟɧɧɸ ɩɿɞɥɹɝɚɥɢ ɞɜɚ ɮɪɚɝ
-ɦɟɧɬɢ ɧɨɜɭɬɜɨɪɟɧɧɹ ɡ ɪɿɡɧɢɦɢ ɦɨɪɮɨɥɨɝɿɱɧɢɦɢ ɜɚɪɿɚɧɬɚɦɢ – ɜɟɪɟɬɟɧɨɩɨɞɿɛɧɢɦ ɬɚ ɟɩɿɬɟɥɿɨʀɞɧɨ
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
Ɂ ɩɟɪɜɢɧɧɢɦ ɚɧɬɢɬɿɥɨɦ ɜɿɦɟɧɬɢɧɨɦ ɨɬɪɢɦɚɧɚ ɩɨɡɢɬɢɜɧɚ ɪɟɚɤɰɿɹ – ɜɢɡɧɚɱɚɥɨɫɶ ɞɢɮɭɡɧɟ ɜɢ
-ɪɚɠɟɧɨɝɨ ɫɬɭɩɟɧɹ ɿɧɬɟɧɫɢɜɧɨɫɬɿ ɤɨɪɢɱɧɟɜɟ,ɩɟɪɟ
-ɜɚɠɧɨ, ɦɟɦɛɪɚɧɧɟ ɡɚɛɚɪɜɥɟɧɧɹ ɦɚɣɠɟ ɜɫɿɯ
ɩɭɯɥɢɧɧɢɯ ɤɥɿɬɢɧ, ɨɞɧɚɤɨɜɟ ɭ ɡɪɚɡɤɚɯ ɡ ɪɿɡɧɢɦɢ
ɦɨɪɮɨɥɨɝɿɱɧɢɦɢ ɜɚɪɿɚɧɬɚɦɢ ɛɭɞɨɜɢ ɧɨɜɨɭɬɜɨ
-ɪɟɧɧɹ.
Ɋɟɚɤɰɿɹ ɡ ɦɚɪɤɟɪɨɦ ɋD117 ɜɢɡɧɚɱɚɥɚɫɶ ɹɤ
ɩɨɡɢɬɢɜɧɚ ɡɚ ɧɚɹɜɧɿɫɬɸ ɞɢɮɭɡɧɨɝɨ ɧɢɡɶɤɨɝɨ ɬɚ ɩɨɦɿɪɧɨ ɜɢɪɚɠɟɧɨɝɨ ɰɢɬɨɩɥɚɡɦɚɬɢɱɧɨɝɨ ɬɚ ɦɟɦ
-ɛɪɚɧɧɨɝɨ ɡɚɛɚɪɜɥɟɧɧɹ, ɚ ɬɚɤɨɠ ɪɟɚɤɰɿɽɸ «dot like» (ɝɪɚɧɭɥɹɪɧɟ ɡɚɛɚɪɜɥɟɧɧɹ ɰɢɬɨɩɥɚɡɦɢ, ɳɨ
ɜɢɡɧɚɱɚɽ ɟɧɞɨɩɥɚɡɦɚɬɢɱɧɢɣ ɪɟɬɢɤɭɥɸɦ) ɛɿɥɶ
-ɲɨɫɬɿ ɩɭɯɥɢɧɧɢɯ ɤɥɿɬɢɧ (ɪɢɫ. 3). Ɂɚɥɟɠɧɨ ɜɿɞ
ɝɿɫɬɨɥɨɝɿɱɧɨɝɨ ɜɚɪɿɚɧɬɭ ɫɬɭɩɿɧɶ ɬɚ ɜɢɪɚɠɟɧɿɫɬɶ ɡɚɛɚɪɜɥɟɧɧɹ ɫɭɬɬɽɜɨ ɧɟ ɡɦɿɧɸɜɚɥɢɫɶ. ɇɚɹɜɧɿɫɬɶ
ɦɟɦɛɪɚɧɧɨɝɨ ɡɚɛɚɪɜɥɟɧɧɹ ɜɢɪɚɠɟɧɨɝɨ ɫɬɭɩɟɧɹ ɿɧɬɟɧɫɢɜɧɨɫɬɿ ɞɢɮɭɡɧɨɝɨ ɯɚɪɚɤɬɟɪɭ ɩɟɪɟɜɚɠɧɨʀ ɛɿɥɶɲɨɫɬɿ ɤɥɿɬɢɧ ɜ ɨɛɨɯ ɡɪɚɡɤɚɯ ɦɚɪɤɟɪɨɦ CD34
ɪɨɡɰɿɧɸɜɚɥɚɫɶ ɹɤ ɩɨɡɢɬɢɜɧɚ ɪɟɚɤɰɿɹ.
Ɋɢɫ. 3. Ƚȱɋɉ,ɟɩɿɬɟɥɿɨʀɞɧɢɣ ɜɚɪɿɚɧɬ.
Ⱥ.ɩɨɡɢɬɢɜɧɚ (+) ɞɢɮɭɡɧɚ ɰɢɬɨɩɥɚɡɦɚɬɢɱɧɚ ɬɚ ɦɟɦɛɪɚɧɧɚ ɪɟɚɤɰɿɹ ɡ ɦɚɪɤɟɪɨɦ CD117.
Ȼ.ȼɢɪɚɠɟɧɨɝɨ ɫɬɭɩɟɧɹ ɤɨɪɢɱɧɟɜɟ ɦɟɦɛɪɚɧɧɟ ɬɚ ɰɢɬɨɩɥɚɡɦɚɬɢɱɧɟ ɡɚɛɚɪɜɥɟɧɧɹ –
ɩɨɡɢɬɢɜɧɚ ɪɟɚɤɰɿɹ ɡ ɩɟɪɜɢɧɧɢɦ ɚɧɬɢɬɿɥɨɦ CD34.
ȼ.ȼɿɞɫɭɬɧɿɫɬɶ ɡɚɛɚɪɜɥɟɧɧɹ ɦɚɪɤɟɪɨɦ SMA ɡ ɜɧɭɬɪɿɲɧɿɦ ɤɨɧɬɪɨɥɟɦ (ɩɨɡɢɬɢɜɧɚ ɪɟɚɤɰɿɹ ɭ ɫɬɿɧɰɿ ɫɭɞɢɧɢ).
Ƚ.əɞɟɪɧɟ ɡɚɛɚɪɜɥɟɧɧɹ ɩɨɧɚɞ 10 % ɩɭɯɥɢɧɧɢɯ ɤɥɿɬɢɧ ɦɚɪɤɟɪɨɦ Ki-67
Ⱥɧɬɢɝɟɧɿɜ ɞɨ ɩɟɪɜɢɧɧɨɝɨ ɚɧɬɢɬɿɥɚ DOG1 ɭ
ɞɨɫɥɿɞɠɭɜɚɧɨɦɭ ɧɨɜɨɭɬɜɨɪɟɧɧɿ ɧɟ ɜɢɹɜɥɟɧɨ,ɩɪɨ
ɳɨ ɫɜɿɞɱɢɬɶ ɜɿɞɫɭɬɧɿɫɬɶ ɤɨɪɢɱɧɟɜɨɝɨ ɡɚɛɚɪɜɥɟɧ
-ɧɹ ɭ ɜɫɿɯ ɡɪɚɡɤɚɯ ɩɭɯɥɢɧɢ. ɐɟ ɪɨɡɰɿɧɸɜɚɥɨɫɶ ɹɤ
ɧɟɝɚɬɢɜɧɚ ɪɟɚɤɰɿɹ. Ɍɚɤɨɠ ɧɟ ɜɢɡɧɚɱɚɥɚɫɶ
ɟɤɫɩɪɟɫɿɹ ɦɚɪɤɟɪɿɜ ɦ’ɹɡɨɜɨɝɨ ɬɚ ɧɟɣɪɨɟɤɬɨ
-ɞɟɪɦɚɥɶɧɨɝɨ ɩɨɯɨɞɠɟɧɧɹ Į-SMA, MSA ɬɚ S100
ɜɿɞɩɨɜɿɞɧɨ ɜ ɨɛɨɯ ɡɪɚɡɤɚɯ ɧɨɜɨɭɬɜɨɪɟɧɧɹ, ɳɨ
ɜɢɤɥɸɱɚɽ ɩɨɯɨɞɠɟɧɧɹ ɩɭɯɥɢɧɢ ɡ ɜɢɳɟɡɚɡɧɚ
-ɱɟɧɢɯ ɬɤɚɧɢɧ, ɧɟɡɜɚɠɚɸɱɢ ɧɚ ɧɚɹɜɧɿɫɬɶ ɫɯɨɠɢɯ
ɦɨɪɮɨɥɨɝɿɱɧɢɯ ɨɡɧɚɤ.
Ʉɨɪɢɱɧɟɜɟ ɹɞɟɪɧɟ ɡɚɛɚɪɜɥɟɧɧɹ, ɯɚɪɚɤɬɟɪɧɟ
ɞɥɹ ɦɚɪɤɟɪɭ ɩɪɨɥɿɮɟɪɚɬɢɜɧɨʀ ɚɤɬɢɜɧɨɫɬɿ Ki-67,
ɜɢɹɜɥɹɥɨɫɶ ɭ 21% ɩɭɯɥɢɧɧɢɯ ɤɥɿɬɢɧ,ɳɨ ɫɜɿɞɱɢɬɶ
ɩɪɨ ɜɢɫɨɤɭ ɩɪɨɥɿɮɟɪɚɬɢɜɧɭ ɚɤɬɢɜɧɿɫɬɶ (ɤɪɢɬɟɪɿɣ
ɨɰɿɧɤɢ: ɩɨɧɚɞ 10% ɡɚɛɚɪɜɥɟɧɢɯ ɧɟɨɩɥɚɫɬɢɱɧɢɯ
ɤɥɿɬɢɧ), ɳɨ ɩɨɹɫɧɸɽ ɜɢɧɢɤɧɟɧɧɹ ɪɟɰɢɞɢɜɭ ɜ
ɩɚɰɿɽɧɬɚ [7].
Ɉɬɪɢɦɚɧɢɣ ɿɦɭɧɨɮɟɧɨɬɢɩ:ɩɨɡɢɬɢɜɧɿ ɪɟɚɤɰɿʀ ɡ
ɦɚɪɤɟɪɚɦɢ ɜɢɦɟɧɬɢɧɨɦ, CD117, CD34 ɬɚ ɧɟɝɚ
-ɬɢɜɧɿ - Į-SMA, MSA ɬɚ S100, ɜɿɞɩɨɜɿɞɚɽ Ƚȱɋɉ.
ɉɪɨɬɟ ɞɥɹ ɛɿɥɶɲɨɫɬɿ ɞɨɫɥɿɞɠɭɜɚɧɢɯ ɧɨɜɨɭɬɜɨɪɟɧɶ ɯɚɪɚɤɬɟɪɧɚ ɧɚɹɜɧɿɫɬɶ ɩɨɡɢɬɢɜɧɨʀ ɪɟɚɤɰɿʀ ɡ ɦɚɪ
-ɤɟɪɨɦ DOG1 [1], ɬɨɞɿ ɹɤ ɦɢ ɨɬɪɢɦɚɥɢ ɧɟɝɚɬɢɜɧɭ.
ɐɟɣ ɮɚɤɬ ɧɟ ɜɢɤɥɸɱɚɽ ɞɿɚɝɧɨɡ Ƚȱɋɉ, ɬɨɦɭ ɳɨ
ɛɥɢɡɶɤɨ 5% ɰɢɯ ɧɨɜɨɭɬɜɨɪɟɧɶ ɧɟ ɟɤɫɩɪɟɫɭɸɬɶ DOG1 [4]. ȼɪɚɯɨɜɭɸɱɢ ɰɟɣ ɮɚɤɬ ɬɚ ɨɫɨɛɥɢɜɨɫɬɿ
ɦɚɥɶɧɟ ɩɨɯɨɞɠɟɧɧɹ,ɦɢ ɜɫɬɚɧɨɜɢɥɢ ɞɿɚɝɧɨɡ Ƚȱɋɉ.
ȼɂɋɇɈȼɄɂ
ɉɿɞ ɱɚɫ ɜɟɪɢɮɿɤɚɰɿʀ ɞɿɚɝɧɨɡɭ Ƚȱɋɉ ɬɚ ɚɧɚɥɿɡɭ ɨɬɪɢɦɚɧɢɯ ɿɦɭɧɨɝɿɫɬɨɯɿɦɿɱɧɢɯ ɪɟɚɰɿɣ ɛɭɥɨ ɡɪɨɛ
-ɥɟɧɨ ɬɚɤɿ ɜɢɫɧɨɜɤɢ:
1. ȼɟɪɢɮɿɤɚɰɿɹ Ƚȱɋɉ ɫɭɩɪɨɜɨɞɠɭɽɬɶɫɹ ɜɚɠɤɢɦ
ɞɿɚɝɧɨɫɬɢɱɧɢɦ ɩɨɲɭɤɨɦ ɬɚ ɩɨɬɪɟɛɭɽ ɩɪɨɜɟɞɟɧɧɹ ɞɢɮɟɪɟɧɰɿɣɧɨʀ ɞɿɚɝɧɨɫɬɢɤɢ ɡ ɜɟɥɢɤɨɸ ɤɿɥɶɤɿɫɬɸ ɦ’ɹɤɨɬɤɚɧɢɧɧɢɯ ɧɨɜɨɭɬɜɨɪɟɧɶ.
2. ȼɫɬɚɧɨɜɥɟɧɧɹ ɜɢɳɟɡɚɡɧɚɱɟɧɨɝɨ ɞɿɚɝɧɨɡɭ ɩɨ
-ɬɪɟɛɭɽ ɜɢɤɨɪɢɫɬɚɧɧɹ ɤɨɦɩɥɟɤɫɧɨʀ ɨɰɿɧɤɢ ɤɥɿɧɿɱ
-ɧɢɯ,ɝɿɫɬɨɥɨɝɿɱɧɢɯ ɬɚ ɿɦɭɧɨɦɨɪɮɨɥɨɝɿɱɧɢɯ ɞɚɧɢɯ.
ɝɥɚɞɤɨɦ’ɹɡɨɜɨɝɨ ɬɚ ɧɟɣɪɨɟɤɬɨɞɟɪɦɚɥɶɧɨɝɨ ɞɢɮɟ
-ɪɟɧɰɿɸɜɚɧɧɹ, ɩɪɨɬɟ ɿɦɭɧɨɮɟɧɨɬɢɩ ɭ ɰɿɣ ɡɚɥɟɠ
-ɧɨɫɬɿ ɫɭɬɬɽɜɨ ɧɟ ɡɦɿɧɸɽɬɶɫɹ.
4. ȼɢɧɢɤɧɟɧɧɹ ɪɟɰɢɞɢɜɭ ɦɨɠɧɚ ɩɨɹɫɧɢɬɢ,
ɫɩɢɪɚɸɱɢɫɶ ɧɚ ɤɨɦɩɥɟɤɫ ɩɨɤɚɡɧɢɤɿɜ: ɝɿɫɬɨɥɨ
-ɝɿɱɧɢɯ (ɩɨɥɿɦɨɪɮɿɡɦ, ɩɨɧɚɞ 5 ɦɿɬɨɡɿɜ ɭ 50 ɩɨɥɹɯ
ɡɨɪɭ) ɬɚ ɿɦɭɧɨɦɨɪɮɨɥɨɝɿɱɧɢɯ (ɦɚɪɤɟɪ Ʉɿ-67
ɡɚɛɚɪɜɥɸɽ ɛɿɥɶɲɟ 10% ɤɥɿɬɢɧ ɩɭɯɥɢɧɢ),ɚ ɬɚɤɨɠ
ɩɪɢɩɭɫɬɢɬɢ ɜɢɧɢɤɧɟɧɧɹ ɜɬɨɪɢɧɧɨɝɨ ɪɨɡɩɨɜɫɸɞ
-ɠɟɧɧɹ ɬɚ/ɱɢ ɧɨɜɨɝɨ ɪɟɰɢɞɢɜɭ.
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1. Diagnostic significance of DOG-1 and PKC-ș expres-sion and c-Kit/PDGFRA mutations in gastrointestinal stromal tumours / C. Wang, M.S. Jin, Y.B. Zou, J.N. Gao [et al.] // Scand J Gastroenterol. – 2013. – Vol. 48, N 9. – P. 1055-65.
2. Gastrointestinal stromal tumors: review on mor-phology, diagnosis and management / E. Fülöp, S. Marcu, D. Milutin [et al.] // Romanian J. Morphology Embryo-logy. – 2009. – Vol. 50, N 3. – P. 319 – 326.
3. Fletcher C.D.M. Diagnostic histopathology of tumors / C.D.M. Fletcher – 4th ed. – Philadelphia: Elsevier, 2013. – 2167 p.
4. Miettinen M. DOG1 antibody in the differential diagnosis of gastrointestinal stromal tumors: a study of 1840 cases / M. Miettinen, Z. F. Wang, J. Lasota // Am. J. Surgical Pathology. – 2009. – Vol. 33, N 9. – P. 1401-1408.
5. Miettinen M. Gastrointestinal stromal tumors: pathology and prognosis at different sites / M. Miettinen, J. Lasota // Seminars Diagnostic Pathology. – 2006. – Vol. 23, N 2. – P. 70 – 83.
6. Miettinen M. Gastrointestinal stromal tumors: re-view on morphology, molecular pathology, prognosis, and differential diagnosis / M. Miettinen, J. Lasota // Arch. Pathol. laboratory Medicine. – 2006. – Vol. 130, N 10. – P. 1466–1478.
7. Odze R.D. Surgical pathology of GI tract, liver, biliary tract and pancreas / R.D. Odze, Goldblum J.R. – 3rd ed. – Philadelphia: Elsevier Health Sciences, 2015. – 1612 p.
8. Retroperitonel liposarcomas: follow-up analysis of dedifferentiation after clinicopathologic reexamination of 86 liposarcomas and malignant fibrous gistiocytomas / E. Fabre-Guilevin, J.M. Coindre, N. D. S. Sainthousen [et al.] // Cancer. – 2006. – Vol. 106, N 12. – P. 2725 – 33.
9. World Health Organisation classificatoin of tu-mors. pathology and genetic of tumors of the digestive system / S.R. Hamilton, L.A. Aaltonen, C. Capella [et al.]; editors S.R. Hamilton, L.A. Aaltonen. – Lyon: IARC Press, 2000. – 314 p.
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1. Wang C, Jin MS, Zou YB, Gao JN, Li XB, Peng F, Wang HY, Wu ZD, Wang YP, Duan XM. Diag-nostic significance of DOG-1 and PKC-ș expression and c-Kit/PDGFRA mutations in gastrointestinal stromal tu-mours. Scand J Gastroenterol. 2013;48(9):1055-65.
2. Fülöp E, Marcu S, Milutin D, et al. Gastrointestinal stromal tumors: review on. morphology, diagnosis and management. Rom J Morphol Embryol. 2009;50(3):319-326.
3. Fletcher CDM, author: Diagnostic histopathology of tumors. 4th ed. Philadelphia: Elsevier Health Sciences; 2013;2167.
4. Miettinen M, Wang ZF, Lasota J DOG1 antibody in the differential diagnosis of gastrointestinal stromal tumors: a study of 1840 cases. The American journal of surgical pathology. 2009;33(9):1401-8.
5. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagrl Pathol. 2006;23(2):70-83.
6. Miettinen M., Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Archives of patho-logy & laboratory medicine. 2006;130(10):1466-78.
7. Odze RD, Goldblum JR, authors: Surgical patho-logy of the GI tract, liver, biliary tract, and pancreas. 3rd ed. Philadelphia: Elsevier Health Sciences; 2015;1067.
8. Fabre-Guillevin E, Coindre JM, Sainthousen NDS, et al. Retroperitoneal liposarcomas: folloẃup analysis of dedifferentiation after clinicopathologic reexa-mination of 86 liposarcomas and malignant fibrous his-tiocytomas. Cancer. 2006;106(12):2725-2733.
9. Hamilton SR, Aaltonen LA World Health Orga-nisation classificatoin of tumors. Pathology and genetics of tumors of the digestive system. Lyon: IARC Press; 2000;314.
