胃血管球瘤误诊为胃间质瘤行内镜下切除致胃壁穿孔反思

目的探讨胃血管球瘤的临床、病理及影像学特点,以减少误诊误治。方法对我院收治的1例误诊为胃间质瘤行内镜下切除致胃壁穿孔的胃血管球瘤的临床资料进行回顾性分析。结果患者因上腹部饱胀不适伴反酸、嗳气3个月入院。经胃镜及超声内镜等检查诊断为胃间质瘤,行内镜下消化道肿瘤全层切除术,术中分离过程中反复出血,分离时致胃壁穿孔巨大,难以内镜下修补,急诊行剖腹探查及胃局部切除术。术后病理检查:胃血管球瘤恶性潜能不能排除。术后患者恢复良好,但因胃血管球瘤恶性潜能不能排除,现密切随访中。结论胃血管球瘤临床表现缺乏特异性,极易误诊为胃间质瘤。临床医师应加强对其认识,提高鉴别诊断能力,谨慎实施内镜下肿瘤全层切术,避免造成严重后果。

Reflective Learning:Gastric Glomus Tumor Misdiagnosed as Gastric Stromal Tumor and Treated by Endoscopic Re-section that Caused Stomach Wall Perforation

Objective To study the clinical manifestations, pathological features and image characteristics of gastric glomus tumor for reducing misdiagnosis and mistreatment. Methods A patient with gastric glomus tumor was misdiagnosed as gastric stromal tumor and treated by endoscopic resection that caused stomach wall perforation, then the clinical data of the pa-tient was retrospectively analyzed. Results The patient was admitted for upper abdominal discomfort with acid regurgitation and belching for 3 months. Endoscopic ultrasonography and gastroscope misdiagnosed it as gastric stromal tumor. Endoscopic full-thickness resection （ EFR） was used to treat the patient. Bleeding occurred during the EFR and a huge perforation formed in the stomach wall. The perforation could not be repaired from endoscope, so the patient was treated by emergency laparotomy for removal of partial stomach. The patient recovered well after the operation, but was followed up because the potential of ma-lignant gastric glomus tumor could not be ruled out according to the result of postoperative pathology. Conclusion The clini-cal manifestations of gastric glomus tumor are lack of specificity and it may be misdiagnosed as gastric stromal tumor easily. Clinicians should strengthen the understanding of gastric glomus tumor, improve the ability of differential diagnosis, and strict-ly control the surgical indications of EFR for avoiding serious consequences.