胃胃肠道间质瘤手术后发生肝多形性平滑肌肉瘤：一例报告
Hepatic pleomorphic leiomyosarcoma after surgery for gastric gastrointestinal stromal tumor: a case report.
作者信息
Muranushi Ryo, Hoshino Kouki, Hagiwara Kei, Yamanaka Takahiro, Ishii Norihiro, Tsukagoshi Mariko, Igarashi Takamichi, Tanaka Hiroshi, Watanabe Akira, Kubo Norio, Araki Kenichiro, Harimoto Norifumi, Ikota Hayato, Shibuya Kei, Miyazaki Masaya, Shirabe Ken
机构信息
Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
Department of Human Pathology, Graduate School of Medicine, Gunma University, Maebashi, Japan.
出版信息
Surg Case Rep. 2019 Apr 16;5(1):62. doi: 10.1186/s40792-019-0622-9.
BACKGROUND
Pleomorphic leiomyosarcomas (PLMSs) are extremely rare tumors. We present the first case of hepatic primary PLMS after surgery for gastric gastrointestinal stromal tumor (GIST).
CASE PRESENTATION
The patient was a 62-year-old man who was referred to our hospital for resection of a hepatic tumor arising after gastric GIST surgery that was resistant to imatinib and sunitinib. A 40-mm tumor in the left lobe of the liver and three small nodules in the right lobe were detected. We performed hepatic left lobectomy and partial resections for three lesions. According to the histopathological and immunohistochemical findings and c-kit gene mutations analysis, the main tumor was diagnosed as a PLMS.
CONCLUSION
It is necessary to consider the possibility that imatinib-resistant GIST recurrence lesions are a different kind of soft-tissue sarcoma. Accurate diagnosis is required to not miss the opportunity for radical excision of PLMS.
背景
多形性平滑肌肉瘤（PLMSs）是极其罕见的肿瘤。我们报告了首例胃胃肠道间质瘤（GIST）手术后发生的肝脏原发性PLMS。
病例介绍
患者为一名62岁男性，因胃GIST手术后出现对伊马替尼和舒尼替尼耐药的肝脏肿瘤而转诊至我院进行切除。在肝脏左叶发现一个40毫米的肿瘤，右叶有三个小结节。我们对肝脏左叶进行了切除术，并对三个病灶进行了部分切除。根据组织病理学、免疫组织化学结果以及c-kit基因突变分析，主要肿瘤被诊断为PLMS。
结论
有必要考虑伊马替尼耐药的GIST复发病灶可能是另一种软组织肉瘤的可能性。需要准确诊断，以免错过PLMS根治性切除的机会。
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