| Objective: Gastrointestinal stromal tumors(GIST) are the most common mesenchymal tissue tumors in the digestive system. About 60% of the gastrointestinal stromal tumor appears in stomach. Clinical features of gastric stromal tumor(GST) are frequently lacking of obvious specificity, such as abdominal pain, distention, dizziness,fatigue, gastrointestinal obstruction. Therefore, the early diagnosis of GST is difficult.We retrospectively analyzed 69 patients with GST who underwent surgery treatment in the Second Affiliated Hospital of Dalian Medical University. We summarized the mainly clinical manifestations and pathological characteristics of GST and explored the advantages or disadvantages of preoperative methods of auxiliary examination of GST patients and then provided evidence for accurate and fast diagnosis of GST.Methods: We collected 69 cases of GST from the Second Hospital Affiliated of Dalian Medical University between June 2006 and August 2014 who underwent surgical treatment and were diagnosed by pathology and immunehistochemisty. Clinical data and imaging results such as computer X computed tomography(CT), B ultrasound and stomach duodenum endoscopy, were investigated in this study. According to the Fletcher criterion of biological behavior of GST, GST was divided into four groups,including very low, low, moderate and high malignant potential. Then, we examined the correlation of CT with GST pathological characteristic.Results: In this group, the most common location of GST patients was the body of stomach(45%), followed by the bottom of stomach(37.7%) and gastric antrum(17.4%). Sixty-seven patients were over 40 years old. The duration of symptoms was from 7 days to 10 years. 79.7%(55/69) of the patients had clinical symptoms. The most common manifestations were abdominal pain and distention(49.3%). Then, other non-specific symptoms were showed in these patients, including 4 cases with abdominal mass, 2 cases with haematemesis and 2 cases with weak. Immunohistochemistry(IHC)staining showed that the positive rates of CD117, CD34, SMA and S-100 were 95.6%(66/69), 88.4%(31/69), 27.9%(19/68) and 11.9%(8/67), respectively. Further, 54patients(78.3%) underwent gastroduodenoscopy and visible gastric tumor was found in47 cases(5 cases with endoscopic biopsy pathology). Forty-seven patients underwent CT(plain or enhanced) and gastric tumor was detected in 43 cases. The detection rates of GST of electronic computer X ray tomography imaging mode and CT were 91.5%and 55.8%, respectively. A total of 68 cases underwent surgical treatment. Very low malignant potential was 4 cases(18.9%). Low malignant potential was 33 cases(28.4%).Moderate malignant potential was 15 cases(20.3%). High malignant potential was 17cases(32.4%). Electronic computer X computed tomography(CT), including plain scan and contrast enhancement, is helpful to discriminate the malignant potential of GST.Conclusions: The clinical manifestations of GSTpatients are complex as well as lacking of specificity. Therefore, the preoperative diagnosis of GIST is difficult.Stomach duodenum endoscopy is demonstrated as the mainly methods of auxiliary examination of GST and the morphology and location of GST can be displayed through it. However, the positive rate of the biopsy is low. CT can be used as the primary way to detect patients with non-specific abdominal symptoms and the scan results can provide useful information for predicting the malignant potential and prognosis of GST. In addition, CT can also be used as a postoperative follow-up method. The combined application of stomach duodenum endoscopy and CT provide more accurateinformation of location, boundary and metastasis of GST and subsequently improves the preoperative diagnostic accuracy. |
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