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[胃肠道上皮下肿瘤]

[Subepithelial tumors of the gastrointestinal tract].

作者信息

Stupnik Silvio, Rafaelli Claudio, González Graciela Osorio, Pestalardo María Luján, Quesada Matías, Viúdez Pedro

机构信息

Servicio de Gastroenterología y Endoscopía Digestiva, CiudadAutónoma de Buenos Aires, Argentina.

出版信息

Acta Gastroenterol Latinoam. 2009 Jun;39(2):118-24.

Abstract

The subepithelial lesions of the gastrointestinal tract are related to mesenchymal tumors and 80% of them are GIST (gastrointestinal stromal tumors). However, there are also other tumors, such as: leiomyomas, schwannomas, lipomas, glomus tumors, carcinoid tumors, aberrant pancreas and polyps or inflammatory tumors. Diagnosis of submucosal tumors is often performed during routine endoscopic examination, they are frequently located at the stomach and in most cases are clinically evidenced by their complications. Endoscopic ultrasonography (EUS) is the elected method for their staging; but other imaging diagnosis methods include computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography scan (PET). The differential diagnosis is made by inmunohistochemical techniques, revealing in the GIST the expression of the antigen CD117, and prognostic factors are determined by size and mitotic index. Surgery is the recommended therapeutic, although in small lesions not exceeding 2 cm it has also been suggested the endoscopic resection guided by EUS and a watchful behaviour based on periodical controls in lesions with benignity criteria. The series here exhibited (2 GIST 1 lyposarcoma, 1 schwannoma and 1 inflammatory fibroid polyp) shows that all these tumors were symptomatic; have been diagnosed using endoscopy and recognized by means of histopathology and immunohistochemical analysis after surgery.

摘要

胃肠道的上皮下病变与间充质肿瘤有关,其中80%为胃肠道间质瘤(GIST)。然而,也有其他肿瘤,如:平滑肌瘤、神经鞘瘤、脂肪瘤、血管球瘤、类癌、异位胰腺以及息肉或炎性肿瘤。黏膜下肿瘤的诊断通常在常规内镜检查时进行,它们常位于胃部,且在大多数情况下通过其并发症在临床上得以证实。内镜超声检查(EUS)是其分期的首选方法;但其他影像学诊断方法包括计算机断层扫描(CT)、磁共振成像(MRI)和正电子发射断层扫描(PET)。通过免疫组织化学技术进行鉴别诊断,在GIST中可显示抗原CD117的表达,预后因素由肿瘤大小和有丝分裂指数决定。手术是推荐的治疗方法,尽管对于不超过2厘米的小病变,也有人建议在EUS引导下进行内镜切除,并对符合良性标准的病变进行定期监测,采取观察等待的策略。这里展示的病例系列(2例GIST、1例脂肪肉瘤、1例神经鞘瘤和1例炎性纤维性息肉)表明,所有这些肿瘤均有症状;通过内镜检查得以诊断,并在手术后通过组织病理学和免疫组织化学分析得以确诊。

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