巨大胃肠间质瘤经MDT讨论新辅助治疗后的手术一例及文献复习

Surgical treamtent of giant gastrointestinal mesenchymal tumor after neoadjuvant therapy:a case report and review of the literature

目的报告巨大胃肠间质瘤新辅助治疗后的手术切除1例及文献复习,探讨甲磺酸伊马替尼术前治疗巨大胃肠间质瘤的最佳手术时机。方法报告1例巨大胃肠间质瘤的诊疗过程并进行文献复习。结果本例患者为47岁女性,以腹部包块、腹痛、腹胀为主要表现,通过CT、穿刺活检等诊断为胃肠恶性间质瘤。初诊肿瘤最大径上下约233 mm×前后117 mm×左右213 mm,多学科讨论认为无法切除R0,依据基因检测结果,予以甲磺酸伊马替尼400 mg/d行术前新辅助治疗。6月后患者肿瘤明显缩小,予以R0切除,组织病理学检查结果为:胃大弯侧间质瘤。术后随访至今,未见复发转移。结论对于初诊无法切除的巨大胃肠间质瘤患者,可选择在分子靶向药物治疗达到最大效益时进行手术,提高R0的切除率。

Objective To report a case of giant gastrointestinal mesenchymal tumor treated by surgical resection after neoadjuvant therapy,and to investigate the optimal timing of surgery for giant gastrointestinal mesenchymal tumor preoperatively treated with imatinib mesylate by reviewing the relevant literature.Methods A case of giant gastrointestinal mesenchymal tumor is reported and the relevant literature is reviewed.Results A 47-year-old woman presented with abdominal mass,abdominal pain,and abdominal distension,and she was diagnosed as having malignant gastrointestinal malignant mesenchymal tumor by CT and puncture biopsy.The maximum diameter of the tumor was about 233 mm×117 mm×213 mm at the initial diagnosis.No recurrence of metastasis was observed in the postoperative follow-up to date.Conclusion For patients with initially unresectable giant gastrointestinal mesenchymal tumor,surgery can be chosen when the maximum benefit of molecular targeted drug therapy is achieved to improve the R0 resection rate.