Okagawa Yutaka, Sumiyoshi Tetsuya, Ihara Hideyuki, Oiwa Shutaro, Tokuchi Kaho, Yoshida Masahiro, Fujii Ryoji, Minagawa Takeyoshi, Morita Kohtaro, Hirayama Michiaki, Kondo Hitoshi, Oyamada Yumiko, Kawarada Yo, Kitashiro Shuji, Okushiba Shunichi
Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido 060-0004, Japan.
Department of Pathology, Tonan Hospital, Sapporo, Hokkaido 060-0004, Japan.
Mol Clin Oncol. 2018 Aug;9(2):168-172. doi: 10.3892/mco.2018.1639. Epub 2018 May 25.
Gastrointestinal stromal tumors (GIST) typically appear as solid masses, and cystic formation is uncommon. Most stomach GISTs with cystic formation progress outside the gastric wall and are frequently misdiagnosed as epigastric cystic tumors derived from pancreas or liver. An asymptomatic 72-year-old male underwent esophagogastroduodenoscopy, which revealed a submucosal tumor (SMT), approximately 50 mm in diameter, at the anterior wall of the gastric angle. The SMT was very soft with positive cushion sign. Endoscopic ultrasonography and contrast-enhanced computed tomography revealed that the SMT was a cystic tumor with solid component. Laparoscopic and endoscopic cooperative surgery were performed to remove the tumor. Histopathological analysis revealed that the tumor was a GIST with cystic formation. To the best of our knowledge, this the first documented case of a cushion sign-positive stomach GIST with cystic formation, which had mainly developed inside the stomach. This case suggests that we should keep in mind the possibility of cystic formation of GIST when the tumor has a solid component, even if it appears as a cushion sign-positive SMT.
胃肠道间质瘤（GIST）通常表现为实性肿块，囊性形成并不常见。大多数伴有囊性形成的胃GIST在胃壁外进展，常被误诊为源自胰腺或肝脏的上腹部囊性肿瘤。一名72岁无症状男性接受了食管胃十二指肠镜检查，结果显示在胃角前壁有一个直径约50毫米的黏膜下肿瘤（SMT）。该SMT质地非常柔软，有阳性垫征。内镜超声和增强计算机断层扫描显示该SMT是一个有实性成分的囊性肿瘤。进行了腹腔镜和内镜联合手术切除肿瘤。组织病理学分析显示该肿瘤是一个伴有囊性形成的GIST。据我们所知，这是首例有文献记载的垫征阳性且伴有囊性形成的胃GIST，其主要在胃内发展。该病例提示，当肿瘤有实性成分时，即使表现为垫征阳性的SMT，我们也应牢记GIST发生囊性形成的可能性。
