Testi Walter, Staffieri Carmen, Consiglio Francesco Maria, Genovese Alberto, Cirianni Daniela, Ranalli Massimo, Bing Camilla, Tumbiolo Salvatore
Istituto di Chirurgia Generale e Specialità Chirurgiche, Università degli Studi di Siena, Siena.
Chir Ital. 2005 Jul-Aug;57(4):515-20.
Gastrointestinal stromal tumours account for fewer than 1% of malignant tumours of the digestive system. Analysing a case referred to us for observation, we review the literature with regard to diagnostic and therapeutic difficulties. A 68-year-old patient was referred to our institute with a diagnosis of "retroperitoneal haematoma". Computerised tomography showed a solid mass with a liquid component, occupying almost the whole of the abdominal cavity. An ultrasonography-guided biopsy examination suggested the presence of a sarcoma. Exploratory laparotomy and the histological examination, which was positive for CD117, CD34 and the smooth muscle marker caldesmon, allowed a diagnosis of gastrointestinal stromal tumour to be made. Thus, no thoroughly reliable and accurate diagnosis of gastrointestinal tumour can be made without surgical exploration and consequent histological and immunohistochemical examinations that still represent the only method capable of confirming or ruling out a diagnosis of gastrointestinal stromal tumour. Such tumours are rare and aggressive and their prognosis is closely related to tumour size and the mitotic index per high power field. Radical resection affords the only possibility of long-term survival.
胃肠道间质瘤占消化系统恶性肿瘤的比例不到1%。通过分析转诊至我院观察的1例病例，我们回顾了有关诊断和治疗难点的文献。一名68岁患者因“腹膜后血肿”诊断转诊至我院。计算机断层扫描显示一个有液体成分的实性肿块，几乎占据整个腹腔。超声引导下活检检查提示存在肉瘤。剖腹探查及组织学检查显示CD117、CD34及平滑肌标志物钙调蛋白呈阳性，从而确诊为胃肠道间质瘤。因此，若不进行手术探查及后续的组织学和免疫组化检查，就无法做出完全可靠且准确的胃肠道肿瘤诊断，而这些检查仍是确诊或排除胃肠道间质瘤诊断的唯一方法。此类肿瘤罕见且具有侵袭性，其预后与肿瘤大小及每高倍视野有丝分裂指数密切相关。根治性切除是长期生存的唯一可能。
