胃肠平滑肌肿瘤159例临床病理特点分析

Smooth muscle tumors of the gastrointestinal tract:a clinico-pathologic analysis of 159 cases

目的探讨胃肠平滑肌肿瘤(SMT)的临床病理特点。方法收集和分析159例胃肠 SMT 的临床和病理资料。结果平滑肌瘤53例、上皮样平滑肌瘤3例、平滑肌肉瘤103例;病变位于胃79例、小肠42例、直肠18例、十二指肠和结肠各10例。主要临床表现为腹痛、消化道出血及腹部包块。内窥镜和 X线钡剂检查联合应用的术前正确诊断率达84.4%。平滑肌肉瘤的核分裂指数5.77±2.30显著高于平滑肌瘤0.31±0.15(P<0.001);有肝转移和复发者 MI 均值7.85±2.65显著高于未发生肝转移和未复发者的3.44±1.62(P<0.001)。结论胃肠平滑肌肿瘤好发于胃和小肠;肿瘤核分裂指数高的 SMT 患者预后较差。

Objective To investigate the clinico-pathologic behavior of smooth muscle tumors(SMT) of the gas- trointestinal tract.Methods The clinical course and pathologic features were analyzed for 159 SMT patients. The number of mitoses seen in 50 high-power fields(HPF) was assessed for each tumor.Results In this se- ries,53 cases were of leiomyoma,3 of epithelioid leiomyoma,and 103 of leiomyosarcoma.49.7% (79) were in the stomach,26.4% (42) in the small bowel,11.3% (18) in the rectum,6.3% (10) in the duodenum and the colon each.The most common presenting symptoms and signs were abdominal pain,gastrointestinal bleeding, and abdominal mass.84.4% of the tumors were diagnosed preoperatively by combining gastrointestinal en- doscopy and barium meal or enema examination.Leiomyoma,including epithelioid leiomyoma,had 0.31±0.15 mitoses/10HPF,and leiomyosarcoma had 5.77±2.30 mitoses/10HPF(P<0.001).Furthermore,in cases of leiomyosarcoma,tumors presenting with liver metastases and/or recurrence had 7.85±2.65 mitoses/10HPF, while those without had 3.44±1.62 mitoses/10HPF (P<0.001).Conclusion SMT of the gastrointestinal tract often occurred in the stomach and the small bowel.Mitotic index is an important criterion to distinguish the benign SMT from malignant.The higher the frequency of mitoses,the worse the prognosis may be.