双气囊小肠镜在不明原因消化道出血的诊断应用

目的 研究双气囊推进式小肠镜在不明原因消化道出血诊断中的价值.方法 对本院2003年7月至2005年11月不明原因消化道出血患者的双气囊推进式小肠镜(double-balloon enteroscopy,DBE)检查结果进行回顾分析,取同期非出血患者的DBE检查作为对照.对出血和非出血性小肠病灶的阳性诊断率进行统计.结果 出血组38例,经口入镜22例,经肛入镜6例,分别从两端入镜10例,发现出血灶35例(92.1%),其中小肠出血31例(81.6%).8例经手术切除并证实诊断,2例经镜下治疗后止血.对照组50例,病灶发现37例(74%),病灶诊出率低于出血组(P＜0.05) .结论 双气囊推进式小肠镜是一种安全、可靠、有效的检查手段,对不明原因消化道出血有较高的诊断价值.     

双气囊小肠镜在不明原因消化道出血的诊断应用

目的 研究双气囊推进式小肠镜在不明原因消化道出血诊断中的价值.方法 对本院2003年7月至2005年11月不明原因消化道出血患者的双气囊推进式小肠镜（double-balloon enteroscopy,DBE）检查结果进行回顾分析,取同期非出血患者的DBE检查作为对照.对出血和非出血性小肠病灶的阳性诊断率进行统计.结果 出血组38例,经口入镜22例,经肛入镜6例,分别从两端入镜10例,发现出血灶35例（92.1%）,其中小肠出血31例（81.6%）.8例经手术切除并证实诊断,2例经镜下治疗后止血.对照组50例,病灶发现37例（74%）,病灶诊出率低于出血组（P＜0.05） .结论 双气囊推进式小肠镜是一种安全、可靠、有效的检查手段,对不明原因消化道出血有较高的诊断价值.     

对胃肠道间质瘤的再认识

胃肠道间质瘤 (gastrointestinalstromaltumor,GIST)是消化道最常见的间叶源性肿瘤 ,长期以来一直被诊断为消化道平滑肌 (肉 )瘤或 (恶性)神经鞘膜瘤。 1 983年 ,Mazur和Clark运用电镜和免疫组织化学重新评估胃间叶源性肿瘤的组织发生 ,发现除个别病例具有明确的平滑肌和神经鞘膜免疫表型和超微结构特征外 ,大部分肿瘤无明确肌性或神经分化特征 ,类似未分化的幼稚间充质细胞 ,从而提出GIST的概念 ,作为在当时情况下难以明确这类肿瘤分化方向的临时替代名称。此后 ,各国学者对GIST进行了深入研究 ,但直至近年发现该肿瘤存在c kit基因的…     

前列腺恶性胃肠道间质瘤一例

患者男,49岁。因无明显诱因感会阴部酸痛不适10d。无尿急、尿频及尿痛,无血尿,在当地医院就诊,B超检查发现盆腔前列腺部位实性占位性病变,CT检查发现前列腺增大约8·03cm×6·58cm,提示前列腺肿瘤。实验室检查:前列腺特异性抗原1·11ng/ml,血清游离前列腺特异性抗原0·2ng/ml,为进一步诊治于2005年3月入本院治疗。直肠指诊:前列腺增大约6cm×8cm,质坚硬,无压痛,中央沟消失,表面不平。X线和ECT检查未发现转移病灶。临床初步诊断为:前列腺肿瘤,肉瘤可能。患者入院1周后行前列腺肿瘤根治术,手术顺利,术中未发现盆腔肿大淋巴结。病理检查:带…     

Malignant gastrointestinal stromal tumor of intestine: a case report

Smooth muscle tumors of the alimentary tract are uncommon.Cancer of small intestine comprises less than 20% of all malignant tumors. A 65-year-old male patient was admitted with complain of pain in abdomen since 7 days. He was diagnosed as a case of acute intestinal obstruction and on laparotomy an extraluminal mass was found at jejunoileal junction. Histopathology revealed a malignant gastrointestinal stromal tumor (GIST) which was confirmed by immunohistochemistry. The case is reported with review of literature and criteria for differentiation between benign and malignant tumors are enumerated.     

Dedifferentiated gastrointestinal stromal tumor: Recent advances

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal lesions of the gastrointestinal tract. A small minority of GISTs exhibit morphologic and phenotypic changes and differentiate into an unusual phenotype through the process of dedifferentiation. Dedifferentiation can occur either de novo or after prolonged treatment with imatinib, a selective tyrosine kinase inhibitor. GISTs can present with various morphologies including rhabdomyosarcoma, angiosarcoma, or undifferentiated pleomorphic sarcoma. The unusual histologic and immunohistochemical characteristics of these tumors can be diagnostically challenging. Therefore, it is essential that the pathologists recognize GISTs with unusual morphology and be aware of the dedifferentiation process.This review aims to provide an overview of the morphologic and molecular features of dedifferentiated GISTs. Additionally, we discuss diagnostic dilemmas and recent immunohistochemical markers that are useful in distinguishing dedifferentiated GISTs from other gastrointestinal tumors.     

Pyogenic granuloma: an unrecognized cause of gastrointestinal bleeding

Pyogenic granuloma is a lobular capillary hemangioma that mostly occurs on the skin, but it is also encountered on the mucosal surface of the oral cavity. Only a few cases in other parts of the digestive tract have been reported in Japanese patients. In this report, two Caucasian patients are described, who presented with gastrointestinal bleeding due to the presence of a pyogenic granuloma. One was located in the distal esophagus and could be treated with local excision and laser-photocoagulation therapy. The other one was located in the small intestine and was removed by surgical resection. Although extremely rare, pyogenic granuloma as a cause of gastrointestinal bleeding needs consideration. The lesion is benign, presumably reactive and can be adequately treated by excision or laser photocoagulation. Immunohistochemistry and/or polymerase chain reaction for herpesvirus 8 can reliably distinguish pyogenic granuloma from Kaposis sarcoma, an important differential diagnosis.     

Gastric bronchogenic cyst presenting as a gastrointestinal stromal tumor

Bronchogenic cyst (BC) is congenital abnormality of the tracheobronchial bud derived from the primitive foregut which is predominantly found in the mediastinum. Surgery remains the most common treatment when malignancy is suspected, or when there are presenting. Only infrequently, is BC located at an extrathoracic site. Although rarely located in the stomach, BC should be considered as a differential diagnosis of gastric neoplasm. For these cases, surgery remains a common choice. Minimally invasive procedures such as endoscopic ultrasonography-guided fine needle biopsy aspiration (EUS-FNA) and endoscopic submucosal dissection (ESD) should also be considered when the diagnosis of BC is suspected. They are valuable diagnostic methods that can assess and identify the location of the lesion, and facilitate histological examination of the cyst. In some cases of more superficial lesions ESD can take the place of surgery as it avoids unnecessary complications of a more invasive procedure. Here we present a case of gastric BC located in the fundus of the stomach that resembled a gastrointestinal stromal tumor (GIST). We discuss its embryology, pathogenesis, radiological, clinical and treatment modalities. We also provide a thorough review of 14 cases (including our own case), which completely meet pathological criteria has been undertaken focusing on symptom, location, treatment, and histological features.     

Jejunal stromal tumor with skeinoid fibers or myenteric plexoma: A case report

Small Intestinal stromal tumors with 'skeinold fibers' are uncommon stromal tumors with an associated controversial histogenesis. Although their microscopic appearance Is suggestive of a smooth muscle nature, they lack specific smooth muscle features, as evident by electron microscopy and Immunohistochemistry. They also appear to lack features of neurogenic origin because they fail to react with neural/neuroendocrine markers such as S-100 protein, neuronapecific enolase and chromogranin. It is interesting, nonetheless, to note that the ultrastructural examination of these tumors may show structures reminiscent of neural differentiation, such as cytoplasmic projections, containing occasional membrane-bound, densecore, neurosecretory type granules, which mimick the long cytoplasmic processes seen In tumors of neural origin. Moreover, the association of these tumors with Von Recklinghausen's neurofibromatosis, as well as the presence of 'skeinoid fibers' in proven neurogenic spindle cell neoplasms such as gastrolntestinal autonomic nerve tumors and schwannomas, suggests that these tumors might also be neurogenic In origin and enhances the diagnostic value of 'skeinold fibers' as a possible ultrastructural marker of neural differentiatioin. Thus, light microscopic evaluation is clearly Insufficient to accurately diagnose these tumors and to determine their histogenesis, electron microscopic and Immunohistochemical studies being neccesary. In this article the histogenesis of small Intestinal stromal tumors with 'skeinold fibers', regarding a jelunal neoplasm In a 63-yearsld patient, is reviewed. The light microscopic, immunohistochemical and ultrastructural features are described and compared with findings usually seen in all those stromal tumors which may raise a differential diagnosis, such as smooth muscle stromal tumors, gastrointestinal autonomic nerve tumors, schwannomas, paragangliomas and fibrosarcomas.     

胃腺癌与胃肠道间质瘤碰撞瘤一例

患者女,76岁.因"无明显诱因腹部隐痛伴胃纳减退及少量黑便半年,加重1周"于2009年7月22日入院.体检未见特殊.实验室检查:血红蛋白106 g/L,血沉42 mm/1 h,余均为阴性.胃镜示胃角、窦至幽门前区广泛溃疡,活检时组织质硬、易出血,活检病理诊断为中分化腺癌.行胃癌根治术,术中见肿块位于胃角至十二指肠球部,最大径约9cm,表面黏膜广泛糜烂及溃疡.     

Malignant gastrointestinal stromal tumor of the gallbladder

Gastrointestinal stromal tumors (GISTs) of the gallbladder are representative of an extremely rare group of tumors. We have encountered a patient with a malignant GIST of the gallbladder and presented it with a review of some articles. A 72-yr-old woman initially presented with right upper quadrant abdominal pain, fever and chills. Emergency cholecystectomy was performed under the impression of gallbladder empyema. Liver metastasis was found at 7 months postoperatively and the patient expired 9 months after the surgery. At the time of cholecystectomy, the gallbladder showed a necrotic serosal surface with an irregular thickened wall. A mass, 6 cm in length and 3 cm in width, encircled the whole wall of the neck and upper body of the gallbladder. Microscopic findings revealed frequent mitotic figures (more than 20/50 HPF) and tumor necrosis. Hyperchromatic, pleomorphic and spindle shaped neoplastic cells that were arranged in a pattern of short fascicles infiltrated the entire layer of the gallbladder. The tumor cells were immunoreactive for CD117 antigen (c-kit protein) and vimentin. They were negative for desmin, smooth muscle actin and S-100 protein. Mutations of the c-kit proto-oncogene were not found in this case. These findings were sufficient to provide enough clinical, histopathological and immunohistochemical evidence in diagnosing our case as a malignant GIST.     

PKCtheta expression in gastrointestinal stromal tumor.

Gastrointestinal stromal tumor is characterized by a gain of function mutation of KIT gene and the expression of c-kit protein, but in 5% of cases, c-kit expression is negative although histological findings of gastrointestinal stromal tumor are most suspicious. The existence of c-kit-negative gastrointestinal stromal tumors points to the need of additional markers for making the diagnosis. In this study, we studied the expression of PKCtheta and correlated their expression with other immunohistochemical profiles of gastrointestinal stromal tumors and evaluated their usability as a diagnostic marker. For this purpose, 220 gastrointestinal stromal tumors were immunohistochemically stained for PKCtheta, c-kit, CD34, alpha-smooth muscle actin and S-100 protein. Additionally, genetic studies of KIT and PDGFRA genes were performed using c-kit-negative or PKCtheta-negative cases. All the 220 masses were either PKCtheta-positive or c-kit-positive. PKCtheta was positive in 212 (96%) cases and c-kit was positive in 216 (98%) cases in the cytoplasm of tumor cells with a diffuse staining pattern. Out of 212 PKCtheta-positive GISTs, 208 (98%) cases were c-kit-positive, 174 (82%) cases were CD34-positive, 62 (29%) cases were SMA-positive and S-100 protein was positive in 54 cases (26%). Genetic analyses on eight PKCtheta-negative cases showed exon 11 mutations of KIT gene in four cases. Two PKCtheta-positive and c-kit-negative GISTs showed mutations of PDGFRA gene. Our study shows that PKCtheta is a useful marker and it may play a role in the development of gastrointestinal stromal tumors. Together with c-kit, PKCtheta immunostaining can be used as an important diagnostic tool in the pathologic diagnosis of gastrointestinal stromal tumors with its high specificity and sensitivity.     

HER-2 status in gastrointestinal stromal tumor

Human epidermal growth factor receptor–2 (HER-2) encodes for the transmembrane glycoprotein HER-2 that is involved in activation of intracellular signal transduction pathways that control cell growth and differentiation. HER-2 is overexpressed in approximately 20% of patients with breast cancer and has been associated with poorer prognosis. Since 1998, the anti–HER-2 antibody trastuzumab has been used for the treatment of patients with HER-2–positive breast cancers. However, little information is available about the relationship between HER-2 and gastrointestinal stromal tumors. This study's purpose was to determine the HER-2 status in gastrointestinal stromal tumors. We found that all 477 cases included in this study were negative (score 0) by immunohistochemistry using HercepTest, and no HER-2 gene amplification was detected in 71 cases submitted to fluorescence in situ hybridization. These results show that HER-2 may not have any role in gastrointestinal stromal tumor pathogenesis and that the neoplasm may not be suitable for treatment with trastuzumab.     

Immunohistochemical comparison of gastrointestinal stromal tumor and solitary fibrous tumor

CONTEXT: The differential diagnosis of gastrointestinal stromal tumors (GIST) and solitary fibrous tumors (SFT) may be a diagnostic challenging because of overlapping clinicopathologic features. Many studies have shown consistent immunoreactivity for CD117 (c-Kit) in GIST. However, only a few studies have evaluated CD117 expression in SFT, and these studies have used an antibody from Santa Cruz Biotechnology. In non-GIST lesions, reactivity with this antibody has been shown to differ from that with a CD117 antibody from Dako Corporation. The immunoreactivity of SFT with the Dako CD117 antibody has not been reported. Conversely, CD99 is a marker for SFT, and its expression in GIST has not been evaluated. OBJECTIVE: To study the immunohistochemical profiles of GIST and SFT to evaluate their diagnostic overlap. DESIGN: We studied the immunoreactivity of 27 unequivocal GIST and 19 unequivocal extra-abdominal SFT for CD117, CD34, CD99, alpha-smooth muscle actin, vimentin, CD31, S100 protein, and muscle-specific actin. All antibodies, including CD117, were from Dako Corporation. RESULTS: We found positive immunoreactivity for CD117 in 100% of GIST and none of SFT; for CD34 in 89% of GIST, and 100% of SFT; for CD99 in 89% of GIST and 100% of SFT; for alpha-smooth muscle actin in 48% of GIST and 31% of SFT; for vimentin in 89% of GIST and 90% of SFT; and for muscle-specific actin in 22% of GIST and none of SFT. None of the GIST or SFT showed immunoreactivity for CD31 and S100 protein. CONCLUSIONS: The major difference between GIST and SFT was strong CD117 immunoexpression in all GIST and an absence of this expression in all SFT. With the exception of muscle-specific actin, the prevalence of immunoreactivity for the markers studied did not differ substantially between these 2 tumors. We conclude that GIST and SFT show distinctly divergent immunoprofiles with respect to CD117 and muscle-specific actin.     

Collision tumor of the stomach: Gastric adenocarcinoma intermixed with gastrointestinal stromal tumor

The synchronous occurrence of tumors of different histological types in the stomach is uncommon. This rare association is usually detected incidentally at gastroscopy, surgery or histopathology. It is still not known whether such association represents an incidental coexistence or indicates a similar pathogenesis in the simultaneous development of tumors of different histological types in the same organ. A 73‐year‐old woman complained of discomfort after eating a Chinese dumpling, and had tarry stools three times. Gastroscopy showed a tumor at the juncture of the gastric fundus and corpus. The tumor was composed of gastric adenocarcinoma and gastrointestinal stromal tumor, in which the two components were intermixed with each other. To the authors' knowledge there are few reports of this extremely rare collision tumor association.     

Calibre persistent submucosal artery of the jejunum: a rare cause of massive gastrointestinal bleeding

Historically a calibre persistent submucosal artery was most often described in the stomach. However in later years it was also discovered in the duodenum and jejunum. It is an uncommon and important cause of massive gastrointestinal bleeding in which failure of detection and early intervention would lead to death. In this paper we report a 27-year-old man with no significant medical history who presented at the emergency unit for recurrent melaena, haematochezia and hypotension. Initial investigations failed to localize the source of bleeding. Emergency exploratory laporatomy revealed a small jejunal mucosal nodule that was actively spurting blood. Histopathological evaluation identified a calibre persistent submucosal artery.     

Plexiform myxoid gastrointestinal stromal tumor: a potential diagnostic pitfall in pathological findings

Gastrointestinal stromal tumors (GISTs) have a rather wide morphologic spectrum. Here, we report a rare variant plexiform GIST in gastric antrum. Microscopically, the tumor showed plexiform or multinodular growth pattern, proliferation of spindle cells, presence of epithelioid cells, and abundant myxoid stroma with thin-walled blood vessels. The histologic features were similar to plexiform fibromyxoma. The typical characteristics of immunohistochemistry (positive for CD34, DOG-1 and CD117) confirmed the final diagnosis of GIST. This is a rare case of myxoid GIST characterized by a plexiform growth pattern.