胃平滑肌肿瘤临床及病理特点

Clinical and pathologic features of gastric smooth muscle tumors

目的探讨胃平滑肌肿瘤的临床和病理特点。方法 1990年～2002年经我院治疗的胃平滑肌肿瘤41例,对其临床及病理资料等进行分析。随访时间为1～5年。结果平滑肌肿瘤的主要临床表现为腹痛、体重减轻及上消化道出血,好发部位是胃底和胃体部。内镜下表现为隆起型、溃疡型、浸润型。内镜活检与术后病理符合率为9.8％。平均25个月的随访中,12例死于转移,6例有局部复发。结论胃平滑肌瘤由于其发病率低临床表现特殊,易造成误诊和漏诊,内镜为诊断GSMT的有效手段,但确诊仍靠病理。肿瘤组织学的恶性程度与局部复发和远处转移明显相关。

Objective The current study was designed to evaluate the clinical manifestations, endoscopic and pathologic characteristics of gastric smooth muscle tumors(GSMT). Methods The clinical, roentgenography and endocopic materials of 41 patients with GSMT were retrospectively reviewed and analyzed including 1～5 years long-term follow-up. Results The clinical presentations of 41 patients with GSMT including abdominal pain, loss of weight, upper gastrointestinal hemorrhage were invariably found. GSMT involved most commonly in the fundus and body of stomach. All patients were examined by endoscopy with protruding (including benign and malignant GSMT), ulcerative lesions and infiltration. 41 cases of GSMT were treated by surgical excision, the coincidence rate of endoscopic biopsy with pathology of resected specimen was 9.8％. During an average of 25 months, 12 patients died of metastasis, local recurrence occurred in 6 patients. Conclusions GSMT is very likely to be misdiagnosed or neglected due to its rarity and specificity. Gastroscopy remains to be valuable set to correct diagnosis of GSMT, but definite diagnosis depends on pathological examination. Malignant diagnosis in pathology, infiltration of tumor cells into the neighboring tissue were all positively related to the local recurrence and metastasis of GSMT.