Bai Chenguang, Dong Min, Shen Wenrong
Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.
Transl Cancer Res. 2020 Oct;9(10):6528-6533. doi: 10.21037/tcr-20-1771.
Gastrointestinal clear cell sarcomas (GICCSs) are malignant mesenchymal tumour that occur in the wall of gastrointestinal tract, mostly in the ileum and rarely in the rectum. These tumours are highly invasive, and often have metastasized via the lymphatic system or bloodstream by the time of diagnosis. In this case, the patient was admitted for gastric fundus mass, who was subsequently found and confirmed by biopsy as clear cell sarcoma of rectum. Computed tomography (CT) and magnetic resonance imaging (MRI) showed multiple metastatic lesions in lymph node, lung, liver and bone. Furthermore, energy spectrum CT was used to confirm that the nature of gastric fundus mass and rectal lesion were consistent. So, this case may be multiple clear cell sarcomas in the rectum and stomach or clear cell sarcoma in the rectum with gastric fundus metastasis. Unfortunately, after several days of immunotherapy, the patient died due to abnormal liver function. At present, GICCS mainly relies on surgical resection, and the effect of radiotherapy and chemotherapy is not good. Therefore, how to find lesions as earlier as possible and make accurate diagnosis is particularly important. CT and MRI are essential examinations in the diagnosis of tumors. Whether they are helpful for the diagnosis of GICCS is the focus of our attention.
胃肠道透明细胞肉瘤（GICCS）是一种发生于胃肠道壁的恶性间叶性肿瘤，多位于回肠，很少见于直肠。这些肿瘤具有高度侵袭性，在诊断时往往已通过淋巴系统或血液循环发生转移。在本病例中，患者因胃底肿物入院，随后经活检发现并确诊为直肠透明细胞肉瘤。计算机断层扫描（CT）和磁共振成像（MRI）显示在淋巴结、肺、肝和骨有多处转移灶。此外，能谱CT用于证实胃底肿物和直肠病变的性质一致。所以，本病例可能是直肠和胃的多发透明细胞肉瘤，或者是直肠透明细胞肉瘤伴胃底转移。不幸的是，经过几天的免疫治疗后，患者因肝功能异常死亡。目前，GICCS主要依靠手术切除，放疗和化疗效果不佳。因此，如何尽早发现病变并做出准确诊断尤为重要。CT和MRI是肿瘤诊断中的重要检查。它们对GICCS的诊断是否有帮助是我们关注的焦点。
