胃肠道多原发恶性肿瘤的影像学

Imaging of Multiple Primary Malignant Tumors in Gastrointestinal Tract

目的 :探讨胃肠道多原发恶性瘤 (multipleprimarymalignanttumor,MPMT)的发病机制、病理特征和影像学诊断价值。材料和方法 :回顾分析28例 (同时性25例 ,异时性3例 )由胃肠造影和(或)CT检查确认,并经内镜或手术病理证实的胃肠道多原发恶性肿瘤资料。就其中25例同时性MPMT的病变器官组合 ,52个病灶的发生部位、大体病理类型 ,以及MPMT的临床意义、影像学检查价值进行讨论 ,并结合微卫星不稳定性 (microsatelliteinstability,MSI)理论 ,初步探讨MPMT的发病机制。结果 :25例同时性MPMT的52个病灶 ,仅1个胃幽门前区早期癌病灶术前检查被遗漏 ;余51个病灶中位于胃30个 ,结直肠10个 ,食管9个 ,小肠2个 ;癌灶发生于同一器官者20例 (80 % ) ;23例为癌 -癌组合 ,2例为癌 -肉瘤组合 ;6例 (24.0 % )为早癌 -早癌组合 ;15例进展期双癌组合中 ,大体病理类型相一致者11例 (73.33 % )。结论 :MSI可作为预示多发癌的一个分子学标记。重视癌症患者的治疗和综合运用胃肠造影、内镜和CT检查技术进行随访,可提高MPMT的检出率和诊断率。

Purpose:To explore the pathogenic,pathological and imaging features of multiple primary malignant tumors(MPMT)in gastrointestinal tract.Materials and Methods:Twenty-eight cases of gastroinˉtestinal MPMT,which were discovered by GI/CT and proved by endoscopic/surgical pathology,were analysed retrospectively.The component organ of the25synchronous MPMT and pathological pattern of the whole52lesions were discussed.The contributing factor of microsatellite instability(MSI)in the pathogenesis of MPMT was also mentioned.Results:Except1lesion,51lesions of the25synchronous MPMT including30in stomach,10colorectum,9esophagus and2small intestine were diagnosed before surgery.Multiple lesions were originated from same organ in20cases(80%);23cases were composed of both carcinomas;2cases of carcinoma with sarcoma and6cases of both early cancer.Of the15adˉvanced cases,11cases(73.33%)existed the identical gross pathological pattern individually.Concluˉsion:As a molecular marker,MSI can provide a new efficient and quick method to predict MPMT.Pay more attention to immediate treatment and follow-up with adaptable imaging examination for malignant patients,may increase the detecting rate of MPMT in gastrointestinal tract.But the pathological features of MPMT,which denotes in this article is still need more further investigation.