40例胃间质瘤临床诊治分析

Diagnosis and treatment of gastric stromal tumor:a studyof 40 cases

目的总结40例胃间质瘤的临床和病理诊断与治疗方法。方法1998年3月至2005年3月共收治40例胃间质瘤,其最常见症状为上消化道出血和腹痛。其中行胃镜检查35例,超声胃镜检查26例,B超检查21例,CT检查16例,MR I检查6例,钡餐透视4例。40例全部进行免疫组织化学染色,标记抗体为CD34、CD117、VIM、SMA、NES、DES、S-100等。结果发生部位:胃底大弯侧14例(35.0%),胃窦大弯侧9例(22.5%),胃底小弯侧9例(22.5%),胃窦小弯侧5例(12.5%),胃底近贲门3例(7.5%),以胃底、胃窦部多见。病理示恶性18例(45.0%),良性12例(30.0%),潜在恶性10例(25.0%)。向平滑肌分化15例(37.5%),向神经分化11例(27.5%),向平滑肌神经双向分化3例(7.5%),缺乏分化9例(22.5%)。CD117(+)37例(92.5%)。结论胃间质瘤的诊断可根据其临床表现、超声胃镜等影像学检查以及CD117等免疫组织化学测定等进行,诊断一旦明确,应行手术切除。

Objective To summarize the clinical and pathological diagnosis and treatment of gastric stromal tumor in 40 patients. Methods Forty cases of gastric stromal tumor from 1998 to 2005 were included in this study. Upper gastrointestinal bleeding and abdominal pain were the most frequent symptoms of gastric stromal tumor. Thirty five patients were examined by gastroscope, 26 cases by endoscopic ultrasound,21 cases by B-ultrasound, 16 cases by CT, 5 cases by MRI and 4 cases by gastrointestinal barium fluorascopy. CD34, CD117, VIM, SMA, NES, DES, S-100 were examined by immunohistochemical stain. All of the cases were operated and the tumors were resected. Results The tumors of 9 cases（22.5% ） were at greater curvature of antrum, 5 cases（ 12.5% ） at lesser curvature of antrum, 14 cases（35.0% ） at greater curvature of fundus, 9 cases（22.5% ） at lesser curvature of fundus and 3 cases（7.5% ） were near the cardiac. The pathological diagnosis showed 18 cases（45.0% ） malignant, 12 cases（30.0% ） benign and 10 cases （25. 0% ） latent malignant. The tumor cells differentiated to smooth muscle cells in 15 cases （37.5%）, nerve cells in 11 cases （27.5%）, bi-directionally in 3 cases （7.5%） and showed no differentiation in 9 cases（ 22.5% ）. CD 117 was positive in 37 cases （92.5%）. Conclusions The diagnosis of gastric stromal tumor depends mainly on clinical manifestations, image examinations （endoscopic ultrasound is the first choice）, and immunohistochemical stain （CD 117）. Operation is the best treatment.