Cavallaro Giuseppe, Paparelli Claudia, Polistena Andrea, Fornari Francesca, Ruperto Mariangela, De Toma Giorgio
Department of Surgery P. Valdoni, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
Ann Ital Chir. 2007 Mar-Apr;78(2):133-6.
Gastrointestinal stromal tumors are rare neoplasms arising from mesenchymal precursor cells of the gastrointestinal tract that may differentiate towards the interstitial cells of Cajal, pacemaker cells regulating autonomous motility of G.I. tract. Grading of GIST has been proven to be as difficult as their classification. Two thirds of GISTs are located in the stomach, 20-50% in the small bowel (one third in the duodenum), and 5-15% in colon and rectum; GISTs, however, may rarely be found also in the oesophagus, omentum, mesentery or the retroperitoneum. The distribuition of these tumors in the stomach is: pars media, 40%; antrum, 25%; pylorus, 20%; in less than 15%, GISTs location is next to the EGJ, in the cardia and in the iundus. The upper gastric third location of GISTs is not common, so their surgical management has been not yet well investigated. Total gastrectomy is considered the therapy of choice for the GIST located next to the EGJ, but wedge resection could be considered a surgical option in selected cases. The Authors describe 2 cases of GIST located just under the upper portion of the stomach and discuss about the different surgical options for GISTs of this region.
胃肠道间质瘤是起源于胃肠道间充质前体细胞的罕见肿瘤，可向 Cajal 间质细胞分化，Cajal 间质细胞是调节胃肠道自主运动的起搏细胞。胃肠道间质瘤的分级已被证明与它们的分类一样困难。三分之二的胃肠道间质瘤位于胃，20% - 50%位于小肠（三分之一位于十二指肠），5% - 15%位于结肠和直肠；然而，胃肠道间质瘤也很少见于食管、网膜、肠系膜或腹膜后。这些肿瘤在胃中的分布为：胃中部，40%；胃窦，25%；幽门，20%；不到 15%的胃肠道间质瘤位于食管胃交界附近、贲门和胃底。胃肠道间质瘤位于胃上部三分之一处并不常见，因此其手术治疗尚未得到充分研究。全胃切除术被认为是位于食管胃交界附近的胃肠道间质瘤的首选治疗方法，但在某些特定情况下，楔形切除术也可被视为一种手术选择。作者描述了 2 例位于胃上部下方的胃肠道间质瘤病例，并讨论了该区域胃肠道间质瘤的不同手术选择。
