Wang Min, Qiu Xia, He Xu, Tian Chuan
Department of Gastroenterology.
Department of Nephrology, The People's Hospital of Nanchuan, Nanchuan District, Chongqing.
Medicine (Baltimore). 2020 Apr;99(16):e19885. doi: 10.1097/MD.0000000000019885.
Gastrointestinal stromal tumor (GIST) is one of the most common malignant mesenchymal tumors of the gastrointestinal tract. They generally arise from the fourth layer (muscularis propria) and rarely from the second or third layer. Although the manifestations of gastric stromal tumors are diverse, to our knowledge, there are only several cases of an extra-gastric stromal tumor in the literature appearing with a pedunculation. Pedunculated large GISTs are not frequent and compress the neighboring organs. When they were huge, it is difficult to differentiate the origin of the masses. Thus, in the clinical setting, physicians should pay more attention to the pattern of manifestation of the gastric stromal tumor.
A 62-year-old man had no gastrointestinal symptoms or significant medical and family histories. During the health examination with US, a cystic-solid tumor was found below liver. The results of the physical examination were unremarkable, and routine laboratory data on admission did not show any abnormal findings.
Computed tomography of the abdomen showed a mixed echoic mass measuring 10 × 8 × 8 cm and located below the liver, adjacent to the gastric antrum. After endoscopic ultrasound-guided fine-needle aspiration, cytopathology showed that the specimen was filled with red blood cells, and it had no malignant cells. Histopathology revealed that the mass was a GIST, and immunohistochemical analysis showed the following: CD117(+), CD34(+), desmin(-), Dog-1(+), Ki-67% <1%, and smooth muscle actin(-).
Surgical resection was performed on the patient.
The lesion was diagnosed as a gastric stromal tumor with a pedicle and an old hemorrhage. The patient's recovery was uneventful. After surgery, computed tomography at the 6-month and 1-year postoperative follow-up visits did not reveal relapse or any metastasis.
In the clinical setting, physicians should pay more attention to the pattern of manifestation of the extra-gastric stromal tumor in patients with a pedicle or hemorrhage. Additionally, endoscopic ultrasound-guided fine-needle aspiration can be used to make an accurate preoperative diagnosis of such diseases, and its findings can serve as an important basis for surgical excision of the lesions.
胃肠道间质瘤（GIST）是胃肠道最常见的恶性间叶性肿瘤之一。它们通常起源于第四层（固有肌层），很少起源于第二层或第三层。尽管胃间质瘤的表现多样，但据我们所知，文献中仅有几例带蒂的胃外间质瘤病例。带蒂的大GIST并不常见，且会压迫邻近器官。当它们体积巨大时，很难区分肿块的起源。因此，在临床实践中，医生应更加关注胃间质瘤的表现形式。
一名62岁男性无胃肠道症状，也无重大病史和家族史。在超声健康检查期间，发现肝脏下方有一个囊实性肿瘤。体格检查结果无异常，入院时的常规实验室数据也未显示任何异常发现。
腹部计算机断层扫描显示一个大小为10×8×8cm的混合回声肿块，位于肝脏下方，毗邻胃窦。经内镜超声引导下细针穿刺后，细胞病理学显示标本充满红细胞，无恶性细胞。组织病理学显示该肿块为GIST，免疫组化分析结果如下：CD117（+）、CD34（+）、结蛋白（-）、Dog-1（+）、Ki-67%<1%，平滑肌肌动蛋白（-）。
对患者进行了手术切除。
病变被诊断为带蒂的胃间质瘤伴陈旧性出血。患者恢复顺利。术后6个月和1年的计算机断层扫描随访未发现复发或任何转移。
在临床实践中，医生应更加关注带蒂或有出血的胃外间质瘤患者的表现形式。此外，内镜超声引导下细针穿刺可用于对此类疾病进行准确的术前诊断，其结果可作为手术切除病变的重要依据。
