小肠间质瘤误诊为卵巢肿瘤9例分析

Analysis of 9 cases of small intestinal stromal tumor misdiagnosed as ovarian tumors

目的探讨9例小肠间质瘤(SISTs)误诊为卵巢肿瘤的原因及避免误诊措施。方法收集2008年6月-2012年11月大连医科大学附属妇产医院收治的9例SISTs临床资料,平均年龄(58±8.75)岁,总结9例患者的临床表现,影像学检查,术中情况及病理结果等。结果 9例SISTs患者均被误诊为卵巢肿瘤。盆腔超声均提示盆腔包块,内部为强回声或低回声伴杂乱光团,RI平均0.44。CT检查提示形态不规则,平扫时肿瘤呈软组织密度。术中发现肿瘤均位于空、回肠,均为外生型,均行小肠部分切除吻合术。免疫组化表型CD117阳性8例(88.9%),CD34阳性6例(66.7%)。病理诊断SISTs中度侵袭危险性5例,高度侵袭危险性4例。结论临床特征、超声及CT对SISTs诊断有较大价值,但确诊需依靠病理及免疫组织化学染色。

Objective To review 9 cases of small intestinal stromal tumor（ SISTs） which were misdiagnosed as ovarian tumors and to discuss measures of avoiding misdiagnosis. Methods Nine cases of SIST treated in Dalian Medical University attached clothing Maternity Hospital were retrospectively analyzed between June 2008 and November 2012. Results The nine patients had an average age of 58 8. 75 and were all misdiagnosed with ovarian tumor. Pelvic ultrasound showed hyperechoic or hypoechoic masses with chaotic light groups. The average RI was 0. 44. CT exam revealed tumors with irregular shape and soft tissue density. During operation,the tumors were found locating in jejunum or ileum and showing exophytic growth. All of the 9 patients underwent partial small bowel resection and anastomosis. Postoperative immunohistochemical studies on the tumor demonstrated CD117 positivity in 8 cases（ 88. 9%） and CD34 positivity in 6 cases（ 66.7%）. 5 cases were diagnosed SIST with moderate risk of invasion and 4 cases with high risk of invasion. Conclusion Clinical features,ultrasound and CT exam are of great value in the diagnosis of SISTs. However the definite diagnosis depends on pathology and immunohistochemical stainings.