| Objective: Discussing the clinical characters, diagnosis and treatment of GIST inorder to decrease the mistaken diagnosis and the missed diagnosis.Method:73GIST patients had been collected from October2006to October2011inXijing Hospital of digestive diseases. Both of these patients had undergone surgicaltreatment and had been clearly identified by pathology and immunohistochemistry.Retrospective analysis of their clinical manifestation, laboratory examination, andpathology were performed. In combination with assessment of immunohistochemist-ry, iconography, endoscopy, therapies and follow up results, other related diseaseswere differentially diagnosed comparing with GIST.Results:1. Materials:73GIST patients identified by pathology after surgical treatme-nt were collected from October2006to October2011in Xijing Hospital of DigestiveDiseases.38males and35females; age from39to72, average age was58. The timebetween occurrence of uncomfortable feeling and doctors’ office visitingdifferentiated from2days to10months and the average interval time was3months.2. Clinical manifestation: The most common manifestation was abdominalpain or discomfort (38.36%,); then alimentary tract hemorrhage such as hematemesisand melena (30.14%,); abdominal lump (23.29%,); other manifestation such aschanging of bowel evacuation habit, progressive dysphagia, anepithymia and loss ofweight (8.22%,).3. Laboratory examination: Among the73patients,24patients’ stool routineshowed occult blood test (+);32patients’ blood routine showed a decreasedhemoglobin level;14patients’ biochemistry test showed different reduction ofalbumin level and total protein level;3patients showed slightly abnormity of tumormarkers.4. Endoscopy: Tumors were differently located in stomach or cardia (36，49.32%), intestine (15,20.55%), duodenum (8,10.96%), esophagus (4,5.48%),rectum (3,4.11%), colon (3,4.11%) and extrogastrointestine(4,5.48%, including1 retroperitoneum,2peritoneum and1mesentery). Among all the patients, lumpsunder endometrium could be seen in26patients. And18of these26patients’endogenous GIST were fungating type or polypoid type under endoscope. Althoughthe boundary of the tumors was clear and the surface was smooth, there were a littlepart of lump had erosion or ulcer on their surface. All these patients had undergonesurgical treatment and had been finally identified with GIST by pathologicaldiagnosis:24benign tumors,31malignant tumors and18borderline tumors.5. CT: There were51patients had undergone CT examination, the lesionswere differently found in stomach14, abdominal cavity14, pelvic cavity8,duodenum3, esophagus3, gastrospleenic region2, liver2, gastropancreatic region1,hepatoduodenal region1, jejunum1, colon1, jejunal and cauda pancreatic region1.All these51patients’ CT results displayed occupying lesions and27of them hadbeen highly doubted to be GIST.6. Pathology and immunohistochemistry: The average diameter of tumors was8cm. When observing the morphology of tumor cells under microscope,48werespindle cell-like tumor,6were epithelia cell-like tumor and19displayed other types.Imunohistochemistry showed that95.89%were CD117positive,80.82%were CD34positive,17.81%were SMA positive,10.96%were S-100positive and78.08%wereKi-67positive. According to the standard of GIST international congress in2004,there were24benign tumors,31malignant tumors and18borderline tumors in allthese patients.7. Follow-up: All these patients had undergone surgical treatment and had beendiagnosed with GIST by pathology and immunohistochemistry. The follow-up timevaries from2months to60months.10patients were lost during follow-up,10diedbecause of other reasons. There were15cases of tumor recurrences and the other38patients hadn’t gotten recurrences yet.Conclusion:1. GIST can occur in any stage of age without gender inclination, and ithas no specific characters in clinical manifestation and no specific changes inserological examination;2. Endoscopy and biopsy are difficult for definite diagnose of GIST;3. Combination of diagnostic imaging and endoscopic biopsy is the main method of diagnosing this disease before getting a surgery. But examination of pathologyand immunohistochemistry also act as an important role.4. CT examination has extraordinarily valuable meaning for diagnosis of GISTfor its assistance in judging the benign or malignant nature of tumors: theenhancement degree of GIST tumors is associated with the tumor size, karyokinesis,growth ability and blood supply. |
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