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女性间质瘤误诊的临床分析

Clinical Analysis of Misdiagnosis of Female Stromal Tumors
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摘要 目的对中国女性间质瘤的误诊进行临床分析。方法回顾性分析3例病例资料和36篇文献资料(79例),共82例。结果共分析胃肠道间质瘤(GIST)71例,胃肠道外间质瘤(EGIST)11例。GIST以腹盆腔包块最多见,可伴腹痛或消化道症状;EGIST以腹胀不适为最常见表现,发现腹盆腔包块、外阴阴道包块及异常阴道流血次之。CA125、CA199在部分病例中升高。影像学检查示包块多位于盆腔,考虑附件实性及囊实性包块最多见,少数CT检查不排除肠道肿瘤来源。术中见GIST来源小肠最多见,而EGIST主要来源于腹腔及外阴阴道。GIST及EGIST的病理检查均为恶性或高度危险性占比最高(64.29%/63.64%),两者免疫组化阳性表达较高的前3位分别为CD117、CD34、DOG1。结论女性间质瘤因临床表现缺乏特异性而被误诊为妇科肿瘤,需要妇科医生进行详细地病史采集和体格检查,并对B超、CT等检查进行仔细鉴别以协助提高间质瘤诊断率,明确诊断需术后病理检查。 Objective To analyze clinical characteristics of misdiagnosis of women stromal tumors.Methods Retrospective analysis for 3 cases of stromal tumor misdiagnosed as gynecological tumor and 36 documents(79 cases),a total of 82 cases.Results There were 71 cases of GIST and 11 cases of EGIST.The commonest symptom of GIST was found of abdominal,pelvic mass,with or not abdominal pain and digestive symptoms.The commonest symptom of EGIST was bloating,followed by abdominal,pelvic mass,vulvovaginal mass,and abnormal vaginal bleeding.The tumor markers of GIST showed that only a portion of patients’CA125 increased,other tumor markers are normal.CA125 and CA199 were increased among EGIST patients.Imaging examination showed that lumps were mostly located in the pelvic cavity,which was considered solid or cystic and solid adnexa lumps.Few CT examinations did not exclude the source of the intestinal tumor.Intraoperatively,GIST was found to derive most from the small intestine.EGIST was mainly derived from the abdominal cavity and vulva and vagina.The pathology of GIST and EGIST both showed the highest proportion of malignant or high risk(64.29%/63.64%).The top three positive expressions within GIST/EGIST were CD117,CD34,DOG1.Conclusion Female stromal tumor was often misdiagnosed as gynecological tumor due to low tumor location and lack of specificity in clinical manifestations.To improve the diagnosis rate of the stromal tumor,detailed medical history should be collected by gynecologists,and B-ultrasound,CT,and other examinations should be carefully identified.Postoperative pathology and immunohistochemistry are still needed to make a definite diagnosis.
作者 张琳 杨熠 王若琳 马利国 ZHANG Lin;YANG Yi;WANG Ruo-lin;MA Li-guo(Department of Gynecology,Shenzhen People's Hospital Affiliated to the Second Clinical School of Jinan University,Shenzhen 518020,Guangdong Province,China)
出处 《罕少疾病杂志》 2021年第6期76-79,共4页 Journal of Rare and Uncommon Diseases
关键词 胃肠道间质瘤 胃肠道外间质瘤 妇科肿瘤 误诊 Gastrointestinal Stromal Tumor Extra-Gastrointestinal Stromal Tumor Gynecological Tumor Misdiagnosis
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