ObjectiveTo investigate the specific CT findings of high-risk gastrointestinal stromal tumors (GISTs). MethodsCT findings of 24 patients with high-risk GISTs from August 2009 to March 2014 proved by surgery and pathology were retrospectively reviewed. ResultsTwelve of the high-risk GISTs were from the stomach, 11 from the small intestine (5 from duodenum, 4 from jejunum, and 2 from ileum), and 1 from the rectum. The biggest transverse diameter of the tumor was between 2.5 and 15.0 cm, and 2 were less than 5 cm and 22 of them were over 5 cm. The tumors appeared as irregular in 20 cases, and with indefinite boundary in 21 cases. Twenty-four tumors showed different levels of necrosis and cystic change, 15 showed ulcer, 2 showed perforation with effusion and pneumatosis, and 3 showed calcification. The enhancement of lesion was mostly moderately to markedly inhomogeneous. High-risk small intestinal stromal tumors had more significant enhancement and vessels. Hepatic metastasis in 3 cases was detected. ConclusionCT features of HRGISTs can be found with certain characteristics, which may contribute to the diagnosis.
摘要:目的:总结十二指肠间质瘤的诊断及外科手术体会。方法:回顾分析1999年~2008年收治的25例十二指肠间质瘤患者的临床资料。结果:临床表现最多见为黑便(14/25)，其次为右上腹不适(11/25)，腹块被(2/25)，无明显症状者(2/25)。术前诊断采用上消化道钡餐造影、CT、B超、胃镜或十二指肠镜、超声内镜检查。25例均手术治疗,其中胰十二指肠切除6例,局部切除18例,组织活检术+胃肠吻合1例。术后随访5~96个月,1、3、5年生存率为95.4%、85.5%和67.3%。结论:综合CT、胃肠道钡餐造影、消化内镜可使大部分十二指肠间质瘤术前得到确诊。手术方式依据肿瘤部位、大小而定,局部切除应选择正确重建方式。Abstract: Objective: To investigate the diagnosis and surgery treatment of duodenal gastrointestinal stromal tumors(GIST).Methods: The clinical data of 25 patients with GIST from 1999 to 2008 were analyzed retrospectively.Results: The most common symptoms of duodenal GIST were melena(14/25), as well as abdominal pain(11/25),abdominal mass, absence of symptoms(2/25). We performed the diagnosis by upper gastrointestinal radiography, gastroscopy, endoscopic ultrasonography and CT scan. All the 25 patients underwent surgical resection, of which 6 with pancreaticoduodenectomy, 18 with local resection, 1 with tissue biopsy and stomach intestinal anastomosis. With 5 to 96 months followup after operation, 1, 3 and 5year survival rates were 95.4%, 85.5% and 67.3%. Conclusion: Preoperative diagnosis of most of GIST was dependent on CT scan, upper gastrointestinal radiography and gastroscopy. The choices of surgical procedures are mainly determined by the location and size of the tumors, local excision should choose the correct way to rebulid alimentary tract.
【摘要】 目的 探讨胃肠道间质瘤(GIST)彩色多普勒超声表现及其在诊断中的应用价值。 方法 回顾性分析2008年1月-2010年7月75例经病理证实的GIST的彩色多普勒超声声像图表现，将其与手术病理结果进行对比分析。 结果 GIST患者中男性高危险度肿瘤的比例较女性高（χ2=7.210，Plt;0.01）。肿瘤的大小、内部回声与其病理危险度高低有关:危险度低者、肿瘤最大径lt;5 cm，内部回声较均匀；危险度高者，肿瘤最大径≥5 cm，内部回声不均匀。肿瘤的彩色血流分布与其危险度高低无明显相关。常规的超声检查对肿瘤检出率较高，在胃及直肠的GIST诊断准确率高于其他部位的GIST。 结论 彩色多普勒超声检查有助于GIST的定位及分化程度的判断，可作为首选检查方法。【Abstract】 Objective To investigate the value of ultrasonography in the diagnosis of gastrointestinal stromal tumors (GIST). Methods The color sonographic performances obtained in 75 patients with pathologically proved GIST from January 2008 to July 2010 were retrospectively analyzed. The sonographic findings were compared with pathological results. Results The proportion of high-risk cancer in male patients with GIST was higher than that in women (χ2=7.210, Plt;0.01). The tumor size and internal echo level were related to its pathologic risk: in low-risk GIST, maximum tumor diameter was lt;5 cm, and internal echo was more homogeneous; in high-risk GIST, maximum tumor diameter was ≥ 5 cm and internal echo was heterogeneous. There was no statistical difference between tumor blood flow distribution and GIST risk. Routine sonography examination had a higher rate of cancer detection and had a higher accuracy in the diagnosis of GIST in the stomach and rectum than those in the other parts. Conclusion Sonography helps to locate and diagnose malignant GIST, which is a common and preferred screening method.
ObjectiveTo discuss the role of imatinib preoperative chemotherapy in treatment of advanced gastrointestinal stromal tumor(GIST). MethodThe related literatures about imatinib preoperative chemotherapy for GIST were reviewed. ResultsImatinib preoperative chemotherapy is an effective treatment for advanced GIST, which significantly improve the resection rate and prolong the overall survival time for patients with advanced GIST. ConclusionsPreoperative imatinib treatment has good effect for metastatic or locally advanced GIST. It should be individualized by gene type of the GIST, which is deserved to be further studied.
ObjectiveTo summarize the pathogenesis and epidemiology features of gastrointestinal stromal tumor(GIST), explore its diagnosis and therapy, and analyze its prognosis. MethodThe pertinent literatures about the pathogenesis, epidemiology features, diagnosis, therapy, and prognosis of GIST in recent years were reviewed. ResultsGIST was non-epithelial tumor which derived from interstitial cells of Cajal, was the most common mesenchymal tumor about accounting for 1%-3% in the digestive tract tumor. The median onset age of patients with GIST was 40-60 years. The gastric stromal tumor was about 60% in all the digestive tract tumor. The current consensus statement was that there was a relation between the pathogenesis of the GIST and proto-oncogene c-kit or platelet-derived growth factor receptor alpha(PDGFRα)gene mutation. But the mutations of PDGFRαand c-kit gene did not emerge at the same time in the same patient. The clinical manifestations of GIST were not specific, and the diagnosis mainly depended on endoscope and image technology, the correct diagnosis depended on pathological examination. The treatment of GIST was given priority of surgery and molecular targeted drug therapy, and the prognosis was closely related to risk assessment stratify of GIST. ConclusionsGISTs are mesenchymal tumors that has a potential of malignant transformation, the risk classification criteria for aggressive clinical course of primary GIST is an important indication for guiding the clinical therapy and prognostic evaluation. Further research would be needed in prevention, diagnosis, treatment, and relapse prevention of GIST.
【Abstract】ObjectiveTo study the diagnosis and the treatment of gastrointestinal stromal tumor (GIST). Methods In this retrospective study, tissue slices, including immunohistochemical examinations, of 48 patients with GIST from January 1999 to December 2004 were collected. All of their clinical symptoms, pathologic characters, and surgical treatment and other information were also analyzed. ResultsTwenty-seven males and 21 females with a mean age of 68 were included in this report. All patients received tumor resections. Tumors were located in the stomach in the 29 cases (60.4%), and 11 cases (22.9%) were in the small intestine. The main clinical manifestations were alimentary tract hemorrhage (52.1%) and abdominal mass (35.4%). Immunohistochemical examination showed the positive rate of CD117 was 83.3%(40/48), and CD34 was 77.1%(37/48). Conclusion GIST mostly occurs at stomach and small intestine in aged people with clinical manifestations of alimentary tract hemorrhage and abdominal mass. The diameter of the mass is an important clinical index to distinguish malignant and benign tumors. The diagnosis of GIST depends on the combination of pathological and immunohistochemistry examinations. Complete regional resection of the tumor may be the most effective treatment.
ObjectiveThis review has summarized in detail the advances in computed tomography (CT) and magnetic resonance imaging (MRI) imaging in evaluating the efficacy of targeted therapy for gastrointestinal stromal tumor (GIST).MethodsTo summarize the image-related guidelines, consensus, international conference reports, and relevant knowledge of clinical research on the evaluation of the efficacy of GIST targeted therapy in recent years.ResultsThe CT and MRI manifestation after targeted treatment of GIST was closely related to pathological changes, including necrosis, cystic degeneration, and bleeding. CT was the preferred imaging method. Functional magnetic resonance imaging, such as diffusion weighted imaging (DWI), had made some progress. The main criteria for evaluating the efficacy of GIST targeted therapy were RECIST 1.1 and Choi criteria.ConclusionCT and MRI play an important role in evaluating the efficacy of targeted therapy for GIST.
目的 探讨小肠间质瘤的临床表现、病理免疫组织化学特征与治疗方法。 方法 回顾性分析2007年1月－2011年7月70例小肠间质瘤患者的临床表现，免疫组织化学特征及治疗手段。 结果 小肠间质瘤患者并无特异性临床表现，主要临床表现包括腹痛、腹胀、血便，腹部包块等。极低风险5例，低风险18例，中风险13例，高风险34例。免疫组织化学显示CD117、DOG1、CD34、S-100、平滑肌肌动蛋白（SMA）、增殖细胞核抗原（Ki-67）、人结蛋白（Desmin）的阳性率分别为95.7%（67/70）、100%（11/11）、51.4%（36/70）、5.7%（4/70）、12.9%（9/70）、60.0% （42/70）、0% （0/70）。治疗上主要以手术完整切除为主，伊马替尼主要用于无法切除，转移或中、高危险度的患者。 结论 小肠间质瘤患者临床表现缺乏特异性表现，发现时往往肿瘤较大、风险度高，选择合理的辅助检查方法可以提高其检出率，目前手术是首选的治疗方式。
ObjectiveTo study the imaging manifestation and clinicopathologic characteristics of rectal stromal tumors. MethodsThe CT and MRI data of 8 patients with pathology proved rectal stromal tumors were retrospectively analyzed, and the correlation between the imaging features and pathological results were analyzed. ResultsAll of 8 cases were malignant. One case was submucosal. It showed irregular thickening of the rectal wall with a diameter of about 2.6 cm, and small ulcers with low-risk could be seen. Three cases were intramural with diameters of about 0.7－10.0 cm. Small lesion located in rectum, and the larger lesions showed internal and external growth across the rectal wall and the main part of the mass was outside the rectum. They were heterogeneous enhancement. One case accompanied with adenocarcinoma. One case was extremely low-risk, two cases were high-risk. Four cases were subserous. The diameter was about 4.2－16.5 cm. CT showed round or lobular, well-circumscribed, exophytic, hypervascular, and heterogeneous masses with cystic necrosis and hemorrhage. They displaced rectum occasionally. Lymphadenopathy in the left groin was developed in one case. Two cases were highrisk, two cases were intermediated-risk. No cases developed intestinal obstruction. Results of immunohistochemistry: CD117 was positive in 7 cases, CD34 positive in five cases, CD117 and CD34 positive in four cases, CD117 negative but CD34 positive in one case, CD117 positive but CD34 negative in three cases. Five cases were followed up, among whom 3 cases recurred. ConclusionsRectal stromal tumor is rare. Imaging appearances of rectal stromal tumors are specific. Its final diagnosis depends on immunohistochemistry examination. It has generally higher degree of malignancy and the prognosis is relatively poor.