Nilojan Jude Selvakumar, Gobishangar Sreekanthan, Sureska Gnanathas Mary, Sarma Sundaramoorthy Iyer Thuraisamy
University Surgical Unit, Teaching Hospital Jaffna, Sri Lanka.
Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka.
Int J Surg Case Rep. 2024 Feb;115:109301. doi: 10.1016/j.ijscr.2024.109301. Epub 2024 Jan 26.
Gastrointestinal stromal tumours are rare, but most common mesenchymal tumours originate from the gastrointestinal tract. Though surgery is the primary treatment, advanced tumours require targeted therapy in combination with surgery.
A 62-year-old lady who presented with abdominal distention and pain was found to have a large abdominal mass. A contrast-enhanced computed tomography revealed a large abdominal mass extending from the epigastrium to the pelvis, with a solitary omental deposit. Despite receiving Imatinib for six months, the disease progressed, and she underwent open En block tumour excision with distal gastrectomy and distal pancreatectomy with Roux-en-Y gastrojejunostomy and part of omental resection after multi-disciplinary team discussions. Histological examination confirmed a spindle-type gastrointestinal stromal tumour, which arrived from the stomach's submucosa; immunohistochemistry showed strong cytoplasmic and membranous positivity for CD117.
While rare (0.1-3 % of GI malignancies), GISTs are most common in the stomach (56 %) and small bowel (32 %). Even large tumours can present with vague symptoms without obstructive features. Advanced tumours can be treated with targeted tumour therapy like Imatinib in combination with surgery. Surgical resection, usually laparoscopic, is the gold standard, but open surgery may be needed for large laparoscopically unresectable tumours.
Though large tumours may present with vague symptoms without obstructive features, they tend to be more aggressive and can progress despite imatinib therapy. While laparoscopic surgery is the gold standard, open surgery is preferable for large, laparoscopically unresectable tumours.
胃肠道间质瘤较为罕见，但却是起源于胃肠道最常见的间叶组织肿瘤。尽管手术是主要治疗方法，但晚期肿瘤需要靶向治疗联合手术。
一名62岁女性因腹胀和腹痛就诊，发现腹部有一巨大肿块。增强计算机断层扫描显示一巨大腹部肿块，从胃上区延伸至盆腔，并有一个孤立的网膜转移灶。尽管接受了6个月的伊马替尼治疗，疾病仍进展，经多学科团队讨论后，她接受了开放性整块肿瘤切除，包括远端胃切除术、远端胰腺切除术、Roux-en-Y胃空肠吻合术和部分网膜切除术。组织学检查证实为梭形胃肠道间质瘤，起源于胃黏膜下层；免疫组化显示CD117在细胞质和细胞膜呈强阳性。
胃肠道间质瘤虽然罕见（占胃肠道恶性肿瘤的0.1%-3%），但最常见于胃（56%）和小肠（32%）。即使是大肿瘤也可能表现为模糊症状而无梗阻特征。晚期肿瘤可采用伊马替尼等靶向肿瘤治疗联合手术。手术切除通常为腹腔镜手术，是金标准，但对于腹腔镜下无法切除的大肿瘤可能需要开放手术。
虽然大肿瘤可能表现为模糊症状而无梗阻特征，但它们往往更具侵袭性，尽管接受伊马替尼治疗仍可能进展。虽然腹腔镜手术是金标准，但对于腹腔镜下无法切除的大肿瘤，开放手术更可取。
