Trivedi Kiran, Toppo Shabnam, Sharma Apoorwa, Jha Rohit Kumar, Bharati Binit, Sinha Tulika
Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Department of Obstetrics and Gynecology, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India.
J Family Med Prim Care. 2024 Dec;13(12):5908-5911. doi: 10.4103/jfmpc.jfmpc_511_24. Epub 2024 Dec 9.
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that arise from interstitial cells of Cajal. Due to vague presentation, location and confusing imaging studies, they tend to mimic gynaecological tumors. They usually diagnosed intra-operative and histopathology followed by tumor specific receptors such as KIT, CD34, CD 117 and DOG 1 are mainstay of diagnosis of GIST. Prognosis of GISTs depends on mitotic rate, tumor size and organ of origin. Resection of mass with tumor free margins is the target of treatment. L ymphadenectomy is not routine. Chemotherapy with tyrosine kinase inhibitors such as Imatinib, Dasatinib, Sorafenib and follow- up depend upon risk category. In this case series, there were four cases with vague symptoms misdiagnosed as gynaecological tumors are reviewed. Preoperatively tumors assumed to be of gynaecological origin were found to be case of GISTs intra-operatively and confirmed by presence of cajal's cells histopathology and mainly by DOG 1, CD117 and tyrosine kinase inhibitor receptors on immunohistochemistry. All belonged to high risk category of GISTs. Any abdomino-pelvic mass detected on ultrasonography and with unusual presentation presenting at primary health centre the possibility of non-gynecological tumors especially GISTs should be kept in mind and should be referred to higher centres for further investigation and proper management.
胃肠道间质瘤(GISTs)是一种罕见的间充质肿瘤,起源于 Cajal 间质细胞。由于临床表现模糊、位置不明确以及影像学检查结果令人困惑,它们往往会被误诊为妇科肿瘤。GISTs 通常在手术中被诊断出来,随后进行组织病理学检查,肿瘤特异性受体如 KIT、CD34、CD117 和 DOG1 是 GISTs 诊断的主要依据。GISTs 的预后取决于有丝分裂率、肿瘤大小和起源器官。切除肿瘤且切缘无肿瘤组织是治疗的目标。淋巴结清扫并非常规操作。使用伊马替尼、达沙替尼、索拉非尼等酪氨酸激酶抑制剂进行化疗以及后续随访取决于风险类别。在本病例系列中,回顾了 4 例因症状模糊而被误诊为妇科肿瘤的病例。术前被认为起源于妇科的肿瘤在手术中被发现是 GISTs 病例,并通过组织病理学检查发现存在 Cajal 细胞得以证实,主要是通过免疫组织化学检测到 DOG‐1、CD117 和酪氨酸激酶抑制剂受体。所有病例均属于 GISTs 的高风险类别。在基层医疗中心,对于超声检查发现的任何腹盆腔肿块,若其表现异常,应考虑到非妇科肿瘤尤其是 GISTs 的可能性,并应转诊至上级中心进行进一步检查和妥善管理。