胃肠道间质瘤的影像学表现与病理分析

The Imaging Features and Pathology Analysis of Gastrointestinal Stromal Tumor

目的提高胃肠道间质瘤(GIST)影像学表现和病理特点的认识水平。材料与方法回顾分析16例经手术病理证实的GIST临床病理及影像学资料,胃肠道双对比造影(DC)15例,CT平扫及双期增强扫描9例,DSA检查2例。结果肿瘤位于胃10例,十二脂肠1例,空肠4例,回肠1例。良性5例,潜在恶性1例,恶性10例。良性直径多<5·0cm,边界清楚,DC主要表现黏膜皱襞受压推移改变,CT平扫密度均匀,增强均匀强化,恶性直径多>5·0cm,边缘分叶,DC黏膜皱襞有破坏,表面可见不规则溃疡,CT平扫密度不均匀,瘤体内有多发状和块状低密度区,增强不均匀强化。DSA发现2例小于3·0cm小肠间质瘤,显示血管丰富。病理,肿瘤多为梭形和上皮细胞,CD117(+)100%,CD34(+)87.5%。结论DC易于发现GIST腔内瘤体,CT定位准确,良恶性判断价值高,DSA显示小体积GIST能我强,GIST确诊有赖于病理组织学和免疫组化检查。

Purpose： The purpose of this study was to evaluate the imaging features of gastrointestinal stromal tumor （GIST） with pathology diagnosis. Materials and Methods： The clinical and imaging findings of 16 patients with surgically and pathologically diagnosis of GISTs were retrospectively analyzed： Of these, the preoperative double - contrast gastrointestinal radiography was performed in 15 patients, computed tomography （CT） scan in 9 patients, and digital subtraction angiography （DSA） in 2 patients. Results： The results showed that the tumors were of gastic （n = 10）, duodenal （n= 1）, jejunum （n =4） and ileum （n = 1） origin, respectively. There were 5 eases of benign stromal tumor, 1 cases of borderline stromal tumor, and 10 cases of malignant stromal tumor： The imaging findings on benign tumors appeared that the tumor size on diameter was always less than 5cm and tile tumor margins were well defined. In malignant GIST, the tumor diameter was always larger than 5 cm and their margins were irregular and lobulated. The image appearances of double - contrast gastrointestinal radiography displayed that tile mucosal fold in benign tumors was pressed and pushed and that the mucosal fold in malignant tumors was destroyed and displayed superficial irregular ulcer. Tile effect of plain and contrast enhancement CT i, aging were homogenous enhancement in benign tumors and heterogeneous enhancement with multiple hypo- density areas in malignant tumors. DSA found 2 cases which tLuuor size was less than 3cm with abundant blood vessels. Histopathological examination indicated that the tmnor consisted of spindle cells and epithelial cells. Immunolfistochemical analysis revealed that tile positive staining was 100% for CD 117 protein and 87.5% for CD 34. Conclusion： The double - contrast gastrointestinal radiography of GIST had an advantage in diagnosis on intraluminal tumors. The CT featmes were well - defined tumor location and could help differentiate the benign from the malignant tumors, The DSA was sensitive to the diagnosis of small GISTs. The final diagnosis of GISTs depended on histopathological and immunohistochemical examination.