Naitoh Itaru, Okayama Yasutaka, Hirai Masaaki, Kitajima Yasuhiro, Hayashi Kazuki, Okamoto Tetsu, Akita Shinji, Gotoh Kazuo, Mizusima Mutsue, Sano Hitoshi, Ohara Hirotaka, Nomura Tomoyuki, Joh Takashi, Yokoyama Yoshifumi, Itoh Makoto
Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, 5-161 Maehatacho, 507-8522 Tajimi, Japan.
J Gastroenterol. 2003;38(12):1181-4. doi: 10.1007/s00535-003-1228-2.
A 59-year-old man with bloody stools, and previously diagnosed with sigmoid colon carcinoma, visited our hospital. Preoperative abdominal ultrasonography (US) showed another tumor, with an uneven irregular surface, measuring about 9 x 5 cm, below the left hypochondrium. The tumor consisted of several cysts. Abdominal computed tomography (CT) showed a multicystic tumor attached to the stomach, and its septum and marginal region were intensely stained on contrast imaging. On magnetic resonance imaging (MRI), low and markedly high signals were revealed in the tumor on T1-weighted and T2-weighted sequences, respectively. Contrast imaging of the upper digestive tract showed extramural compression of the greater curvature of the antral stomach by the tumor. The tumor was partially imaged by endoscopic ultrasonography (EUS), but continuity to the stomach was not confirmed. On abdominal angiography, the tumor was slightly stained via the gastroepiploic arteries. Surgical treatment was performed to excise both the gastric tumor and the sigmoid colon carcinoma. The gastric tumor was removed with gastric wall tissue where the tumor was attached to a 2-cm pedicle. It was multicystic, contained watery fluid, and had a smooth outer surface. Histologically, the tumor consisted of multiple irregular cysts without epithelial lining, and solid epitheloid cell nests in between. The tumor cells had clear or eosinophilic cytoplasm and round nuclei. No mitotic figures were seen. The tumor cells in the pedicle were connected with the muscularis propriae of the stomach. Immunohistochemistry showed c-kit-positive, CD34-positive smooth muscle actin (SMA)-negative, and S-100-negative staining of tumor cells. The final diagnosis was gastrointestinal stromal tumor (GIST).
一名59岁男性，有便血症状，此前被诊断为乙状结肠癌，前来我院就诊。术前腹部超声（US）显示左季肋部下有另一肿瘤，表面凹凸不平，大小约9×5 cm。该肿瘤由多个囊肿组成。腹部计算机断层扫描（CT）显示一个附着于胃的多囊性肿瘤，其间隔和边缘区域在对比成像时呈强烈染色。在磁共振成像（MRI）上，肿瘤在T1加权序列上呈低信号，在T2加权序列上呈明显高信号。上消化道对比成像显示肿瘤对胃窦大弯处有壁外压迫。肿瘤通过内镜超声（EUS）部分成像，但未证实与胃的连续性。腹部血管造影显示肿瘤通过胃网膜动脉有轻微染色。进行了手术治疗，切除了胃肿瘤和乙状结肠癌。胃肿瘤连同附着肿瘤的胃壁组织一并切除，蒂长2 cm。肿瘤为多囊性，内含水样液体，外表面光滑。组织学上，肿瘤由多个无上皮内衬的不规则囊肿和其间的实性上皮样细胞巢组成。肿瘤细胞胞质清晰或嗜酸性，核圆形。未见有丝分裂象。蒂部的肿瘤细胞与胃固有肌层相连。免疫组织化学显示肿瘤细胞c-kit阳性、CD34阳性、平滑肌肌动蛋白（SMA）阴性、S-100阴性。最终诊断为胃肠道间质瘤（GIST）。
