胃肠道间质瘤的影像学表现及其病理分析

Imaging feature and pathological analysis of gastrointestinal stromal tumors

目的分析胃肠道间质瘤的影像学特点,探讨消化道造影及CT扫描对该肿瘤的诊断价值。方法回顾性分析经临床手术病理证实的57例胃肠道间质瘤的影像学资料,并参照其病理进行良恶性分析。结果 57例胃肠道间质瘤良性9例,占15.8%,恶性48例,占84.2%;贲门胃43例,占75.4%:小肠12例,占21.1%;肠系膜2例,占3.6%。直径<3.0cm5例,占8.77%;直径3.0～5.0cm23例,占40.35%;直径>5.0cm29例,占50.88%。术前转移2例,占3.5%。结论 (1)消化道造影与CT扫描影像学表现有助于胃肠道间质瘤的诊断;(2)肿瘤发生的部位、大小、生长方式、强化程度、邻近组织有无受浸及转移、风险等级是胃肠道间质瘤良恶性判断的重要标准;(3)影像学表现及病理为胃肠道间质瘤的临床治疗及预后提供重要参考价值。

Objective To analyse the imagings features of gastrointestinal stromal tumors (GIST) and to evaluate CT 、upper gastrointestinal contrast in the diagnosis of the disease. Methods A series of 57 gastrointestinal stromal tumor cases proved by operative and pathologic examination were reviewed retrospectively,Then analyse them according to pathology. Results 9 cases were benign,48 cases were malignant; The features of upper gastrointestinal contrast: benign cases were Small and most of them were single. They show regular shape and intraluminal growth. malignant cases show irregular、lobular and large shape. The tumors present intraluminal growth、 extraluminal growth or both of them,accompanied with destroyed mucosal. The features of CT: bengin cases were round or oval mass. The diameter was less than 3cm. The density was even with homogeneous enhancement after intravenous contrast medium. Where as the density of malignant mass was even with low density necrosis within the mass,obviously inhomogenous enhancement was usually showed. The diameter was more than 5cm. 57cases were coloured by immunohistochemistry. The percentage of positivity for the CD117 was 92. 9% . CD34 was 85. 9% . SMA、S ～ 100 in some cases were positivity、weakly positive or negative. Conclusion 1. upper gastrointestinal contrast and CT were helpful for the diagnosis of gastrointestinal stromal tumor. 2. The position、size、pattern of growth enhancement and metastasis of the tumors is the important standards in the diagnosis between benign and Malignant tumors. 3 Imaging feature and pathology provide important references in treatment and prognosis.