Tahara Tomomitsu, Shibata Tomoyuki, Nakamura Masakatsu, Yamashita Hiromi, Yoshioka Daisuke, Okubo Masaaki, Maruyama Naoko, Kamano Toshiaki, Kamiya Yoshio, Nakagawa Yoshihito, Fujita Hiroshi, Nagasaka Mitsuo, Iwata Masami, Takahama Kazuya, Watanabe Makoto, Arisawa Tomiyasu, Hirata Ichiro
Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
Case Rep Gastroenterol. 2010 Mar 20;4(1):111-117. doi: 10.1159/000292433.
We report the case of a 56-year-old woman who had a gastrointestinal stromal tumor (GIST) of the stomach. She was admitted to our hospital for epigastric pain, nausea, and severe acute anemia (hemoglobin level 4.3 g/dl). Esophagogastroduodenoscopy revealed a narrow stalk-like based, hemorrhagic and uneven protruding lesion in the lesser curvature of the gastric upper corpus. Although the tumor was less than 2 cm in diameter and was probably a benign GIST according to histology, laparoscopy-assisted local resection was needed because the patient had continuous severe anemia and epigastric pain. Histological assessment showed that the elongated spindle-like tumor cells originated from the intrinsic muscle layer, and was shown with growth to the mucosal side, cropping out to the surface in most areas of the protruding lesion. Only a small part of the tumor was within nontumoral gastric mucosa. Most of the tumor cells demonstrated immunoreactivity for KIT and CD34 in the cytoplasm but not for αSMA, S100, and desmin. Mitotic activity (0/50 high power field) and the labeling index for MIB-1 (about 1%) were low. The GIST of the stomach described in this report was a rare case with a narrow stalk-like based, uneven protruding mass presenting with severe acute anemia despite small size.
我们报告了一例56岁患有胃胃肠道间质瘤（GIST）的女性病例。她因上腹部疼痛、恶心和严重急性贫血（血红蛋白水平4.3g/dl）入院。食管胃十二指肠镜检查显示胃体上部小弯侧有一个窄蒂状、出血且不均匀突出的病变。尽管肿瘤直径小于2cm，根据组织学可能为良性GIST，但由于患者持续严重贫血和上腹部疼痛，仍需要腹腔镜辅助局部切除。组织学评估显示，细长的梭形肿瘤细胞起源于固有肌层，向黏膜侧生长，在突出病变的大部分区域露出表面。只有一小部分肿瘤位于非肿瘤性胃黏膜内。大多数肿瘤细胞在细胞质中对KIT和CD34呈免疫反应性，但对αSMA、S100和结蛋白无反应。有丝分裂活性（0/50高倍视野）和MIB-1标记指数（约1%）较低。本报告中描述的胃GIST是一例罕见病例，尽管肿瘤体积小，但呈窄蒂状、不均匀突出的肿块，并伴有严重急性贫血。
