胃间质瘤的诊断和治疗(附30例报告)

目的　总结 3 0例胃间质瘤的临床和病理诊断与治疗方法。方法　 1 998年 3月至 2 0 0 3年 2月共 3 0例胃间质瘤 ,其最常见症状为上消化道出血和腹痛。其中行胃镜检查 2 6例 ,超声胃镜检查 2 1例 ,B超检查 2 3例 ,CT检查 1 6例 ,MRI检查 6例。 3 0例全部进行免疫组织化学染色 ,标记抗体为CD3 4、CD1 1 7、VIM、SMA、NES、DES、S1 0 0等。结果　发生部位为 :胃底大弯侧 1 1例 (3 7% ) ,胃窦大弯侧 6例 (2 0 % ) ,胃底小弯侧 6例 (2 0 % ) ,胃窦小弯侧 4例 (1 3 % ) ,胃底近贲门 3例 (1 0 % ) ,以胃底、胃体部多见。病理示恶性 1 2例 (4 0 % ) ,良性 9例 (3 0 % ) ,潜在恶性 9例 (3 0 % )。向平滑肌分化 1 2例(4 0 % ) ,向神经分化 9例 (3 0 % ) ,向平滑肌神经双向分化 2例 (7% ) ,缺乏分化 7例 (2 3 % )。CD1 1 7(+)2 7例 (90 % )。结论　胃间质瘤的诊断可根据其临床表现、超声胃镜等影像学检查以及CD1 1 7等免疫组织化学测定等进行 ,诊断一旦明确 ,应行手术切除

Diagnosis and treatment gastric stromal tumor: a report of 30 cases

Objective To summerize the clinical and pathology diagnosis and treatment of gastric stromal tumor in 30 patients. Methods Thirty cases of gastric stromal tumor from 1998 to 2003 were included in this study. Upper gastro-intestinal bleeding and abdominal pain were the most frequent symptom of gastric stromal tumor. Twenty six patients were examined by gastroscope, 21 cases by EUS, 23 cases by B-ultrasound, 16 cases by CT, 6 cases by MRI. CD34, CD117, VIM, SMA, NES, DES, S100 were detected by immunohisto chemistry stain. All of the cases were operated or and the tumors were resected. Results 20%(6 cases) of the tumor were at greater curvature of antrum, 13%(4 cases) at lesser curvature of antrum, 37%(11 cases) at greater curvature of fundus, 20%(6 cases) at lesser curvature of fundus and 10%(3 cases) were near the cardiac. The pathological diagnosis showed 40%(12 cases) malignant, 30%(9 cases) benign and 30%(9 cases) lateren malignant. The tumor cell differentiated to smooth muscle cells in 12 cases (40%), nerve cell in 9 cases(30%), bi-directionally in 2 cases(7%) and showed no differentiation in 7 cases(23%). CD117 was positive in 27 cases(90%). Conclusions The diagnosis of gastric stromal tumor depends mainly on clinical manifestations, image examinations (EUS is the first choice et al), and immunohisto chemistry stain(CD117). Operation is the best treatment.