胃血管球瘤临床病理分析(附4例)

Clinicopathological analysis of gastric glomus tumor(4 cases)

目的:探讨胃血管球瘤(gastric glomus tumor,GGT)的临床表现、病理学特征、鉴别诊断、生物学行为等特点,以加强对该病的认识,提高该疾病的诊治水平。方法:收集临沂市人民医院2021年4月-2022年11月诊断的4例胃血管球瘤临床资料,分析其临床表现,病理学特征,免疫组化表型,手术方式等特点,并复习相关的文献。结果:4例GGT患者中,临床表现为腹痛、腹胀、反酸等。1例为良性胃血管球瘤,3例为恶性潜能未定的胃血管球瘤;肿瘤病灶3例位于胃窦大弯侧,1例位于胃窦后壁。肉眼观:瘤体最大径1.5~2.5 cm,平均1.8 cm,均为单发,切面灰白色,实性。镜检:4例GGT均侵犯固有肌层,肿瘤细胞大小一致,呈圆形或者卵圆形,胞质淡嗜伊染色,边界清楚,细胞核呈圆形,居中,核分裂象不明显。免疫组化表型:4例肿瘤SMA、Vimentin均表达阳性,部分Bcl-2和Syn阳性,Ki67阳性指数3%~5%,平均值为4.5%。结论:胃血管球瘤是一种胃肠道少见的间叶性肿瘤,其临床特征与胃肠道间质瘤、神经内分泌肿瘤、平滑肌瘤等其他间叶组织来源的肿瘤相似,需借助组织病理学特征及免疫组化标记等加以鉴别。

Objective:To investigate the clinical presentation,differential diagnosis and biological behavior of gastric glomus tumor(GGT).Methods:The clinical data of 4 cases of gastric glomus tumor diagnosed in Linyi People's Hospital from April 2021 to November 2022 were collected.The clinical presentation,pathological features,immunohistochemical phenotypes,surgical modalities and other characteristics were analyzed,and the relevant literature were reviewed.Results:In the 4 patients with GGT,the clinical presentation included abdominal pain,abdominal distension,acid reflux and so on.One case was benign gastric glomus tumor,and three cases were undetermined malignant potential GGT.3 cases were located in the greater curvature of the gastric sinus,1 case in the posterior of the gastric sinus.Grossly,all tumors were single,maximum diameter was 1.5~2.5 cm(average diameter of 1.8 cm),with gray cut surface and solid quality.Microscopically,all the four cases of GGT invaded the muscularis propria.Tumor cells were round or oval with uniform size.The cytoplasm was stained with eosinophilic staining.The boundaries were clear.Tumor nuclei were round and centered,without significant nuclear division.The immunohistochemical staining showed 4 cases were positive in SMA,Vimentin,some were positive in Bcl-2 and Syn.Ki67 index was 3%~5%,with an average of 4.5%.Conclusion:Gastric glomus tumor is a rare mesenchymal tumor of the gastrointestinal tract.Its clinical features are similar to gastrointestinal stromal tumor,neuroendocrine tumor,leiomyoma and other mesenchymal tissue derived tumors,and its definite diagnosis depends on pathological and immunohistochemical examination.