胃肠间质瘤并发食管癌13例临床分析

Clinical analysis of 13 cases synchronous occurrence of gastrointestinal stromal tumor and esophageal carcinoma

目的:探讨胃肠间质瘤合并食管癌的诊断与治疗。方法:回顾性分析我院2008年1月至2012年1月13例胃肠间质瘤合并食管癌患者的临床、病理及预后资料。结果:8例于术中发现间质瘤病变,其余5例术后病检偶然发现,所有间质瘤均发现存在于胃,直径0.3~2.2 cm,术后均证实为梭型细胞间质瘤,DOG1阳性13例,CD117阳性13例,CD34阳性12例,核分裂计数均<5个/50HPF,均为低度或极低度危险性间质瘤,通过随访发现其中5例病人因食管癌远处转移死亡,1例复发,其余均健在。结论:胃肠间质瘤合并食管癌并不少见;并发的胃肠间质瘤多为早期病灶,恶性程度低,术前难以明确诊断,术中探查和术后仔细的病理检查是发现小间质瘤最可靠的方法;术中完整切除间质瘤,是防止复发的关键;预后主要取决于食管癌恶性程度。

Objective： To evaluate the prevalence of GISTs in patients with esophageal carcinomas and to describe the clinical and pathologic features of these patients and their effect on the surgical procedure and adjuvant treatment strategy. Methods： The clinical and pathologic data of 13 patients synchronous occurrence of gastrointestinal stromal tumor with esophageal carcinoma from January 2008 to January 2012 were analyzed retrospectively in our hospital. Results： Eight of the patients were diagnosed with GISTs intraoperatively,and GISTs were confirmed in the remaining 5 patients coincidentally during postoperative pathological inspection. All the GISTs were confirmed as the spindle-cell type and located in the stomach with a variation in size from 0. 3 cm to 2. 2 cm（ median 0. 76 cm）,and the mitotic index was less than 5/50 high-power fields（ HPFs） in all GISTs. The immunohistochemistry of the GISTs showed positivity for DOG1： 100%（ 13/13）,CD117： 100%（ 13/13）,CD34： 92. 3%（ 12/13）. All the GISTs were classified as low or very low risk of malignant potential,and none of the patients received adjuvant therapy for the GISTs. After a median follow-up period of 60 months,five patients died from metastasis of the esophageal carcinoma,and one patient was alive with cancer recurrence. The remaining patients were alive without disease. No patients experienced GIST recurrence or metastasis. Conclusion： Synchronous occurrence of GISTs and esophageal carcinomas is not as rare as expected,and the patients with concurrent GISTs and esophageal carcinomas are mainly asymptomatic or incidentally diagnosed and show some of the low malignant characteristics. An alteration in the surgical therapy procedure should be considered in these patients. The prognoses of these patients are greatly determined by the esophageal carcinomas.