胃肠道间质瘤伴肺转移一例病例报道及文献回顾

发布时间：2018-01-04 18:23

本文关键词：胃肠道间质瘤伴肺转移一例病例报道及文献回顾　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:胃肠道间质瘤(Gastrointestinal stromal tumors,GIST)是消化系统比较常见的一种间叶组织来源的实体肿瘤,肝脏和腹膜转移是其主要的转移部位,发生肺转移在临床上是实属罕见的。本文通过分析大连医科大学附属第一医院腹部急症外科所收治的一例小肠间质瘤伴肺转移的病例资料,并结合国内外相关文献来探讨胃肠道间质瘤伴肺转移的临床表现特点、诊断、治疗方法及预后情况,指导临床治疗。方法:通过分析2009年2月-2015年3月期间大连医科大学附属第一医院腹部急症外科收治的一例小肠间质瘤伴肺转移病人的临床资料,并结合相关国内外文献报道的5例胃肠道间质瘤伴肺转移病人的临床资料,进行回顾性分析和总结胃肠道间质瘤伴肺转移的临床特点、影像学表现、病理学及免疫组织化学特征、治疗方法与预后情况。结果:本院所收治的一例小肠间质瘤伴肺转移的患者入院后完善相关辅助检查,患者术临床诊断为小肠肿瘤。术中见腹腔内肿物实性,包膜完整,大小15×15cm,切开肿物质白色,肿物位于小肠壁,距盲肠约20cm,远端小肠及结肠内可见大量血液,术中距肿物10cm行小肠部分切除(含肿物)。术中诊断为小肠间质瘤合并出血。术后病理回报:小肠间质瘤(高风险),肠管两侧手术切缘均为阴性。术后免疫组织化学检查结果为:CD117(+),CD34(-)。术后患者恢复良好,建议患者口服分子靶向药物甲磺酸伊马替尼进行辅助治疗,但患者及家属因经济原因拒绝了药物辅助治疗。术后嘱患者每隔半年来我院复查一次,术后第4年,患者又因腹部不适伴咯血再次入院,复查胸腹部CT和腹部CT考虑为小肠间质瘤术后复发伴肺内及肝内转移。患者因发生肺转移,且复发肿瘤较大,手术无法完整切除,因此建议患者口服分子靶向药物甲磺酸伊马替尼进行治疗,定期随访。随访至今2016年,患者身体状况良好,复发和转移病灶明显缩小。通过笔者大量查阅文献,目前国内外总共报道了5例胃肠道间质瘤伴肺转移的患者,这5位患者发病平均年龄53.4岁,有4名男性患者和1名女性患者。术前影像学检查和术中探查,能够较准确地判断肿瘤的大小、侵袭生长和远处转移情况。其中,有三个患者确诊后接受了手术完整切除,有两个患者确诊后全程接受了药物治疗。文献报道的这5例胃肠道间质瘤伴肺转移的患者中,均伴有其他远处器官的转移,有两例是分别术后5年和10年才发现远处肺转移,其余3例首次确诊时就已经发现有肺转移。病理以及免疫组织化学检查是诊断胃肠道间质瘤的金标准,这5例患者病理免疫组织化学检查CD117表达均为阳性,有3例CD34表达阳性,。5例患者确诊后均接受了分子靶向药物伊马替尼治疗,确诊后分别随访5年至10年不等,患者的临床症状都得到了部分缓解。结论:胃肠间质瘤患者发生肺转移在临床上是非常罕见的,临床症状不典型,生物学行为比较复查,在临床上很难准确预测,良性和潜在恶性肿瘤者也可复发及转移,诊断主要依靠影像学、术后病理检查及免疫组织化学检测。首诊为腹腔内及肺转移患者,一般为病程晚期,失去手术最佳时机,但确诊后给予全程分子靶向药物伊马替尼治疗,能明显缓解患者预后及改善生活质量。
[Abstract]:Objective: gastrointestinal stromal tumor (Gastrointestinal stromal, tumors, GIST) is a kind of digestive system common mesenchymal tumors, liver and peritoneal metastasis is the main metastatic site, lung metastasis is rare in clinic. In this paper, through the analysis of Dalian Medical University First Affiliated Hospital of the acute abdomen surgery from a case of small intestinal stromal tumor with lung metastasis cases, combined with the related literature at home and abroad to discuss gastrointestinal stromal tumors with clinical features of lung metastasis, diagnosis, treatment and prognosis and guiding clinical treatment. Methods: through the analysis of February 2009 -2015 year in March in the First Affiliated Hospital of Dalian Medical University during the period of acute abdomen from a case of small intestinal stromal tumor with lung metastasis in patients with clinical data, combined with relevant literatures of 5 cases of gastrointestinal stromal tumors with metastatic lung disease The clinical data, were retrospectively analyzed and summarized gastrointestinal stromal tumors with clinical features of lung metastasis, imaging findings, pathological and immunohistochemical features, treatment methods and prognosis. Results: the hospital treated a case of intestinal stromal tumor with lung metastasis of the patients after admission to improve the relevant auxiliary examination, clinical diagnosis of patients with small bowel tumors. Intraoperative findings of intra-abdominal mass solid, capsule integrity, size 15 * 15cm, and the tumor is white, tumors located at about 20cm away from the wall of the small intestine, cecum, colon and distal small intestine showed a large amount of blood, intraoperative tumor from 10cm for partial small bowel resection (including tumor). Intraoperative diagnosis of small intestinal stromal tumor with bleeding. Postoperative pathology: gastrointestinal stromal tumors of the small intestine (high risk), on both sides of the surgical margins were negative. The immunohistochemical examination results: CD117 (+), CD34 (-). Postoperative patients recovered well and advise patients Oral targeted drug imatinib adjuvant therapy, but the patients and their families because of economic reasons refused treatment. Postoperative patients every six months in our hospital review once, fourth years after surgery, patients with abdominal discomfort associated with hemoptysis readmission, review thoracic abdominal CT and abdominal CT considering the small intestinal stromal tumor recurrence with lung and liver metastasis. Patients with lung metastasis, and recurrence of larger tumors, surgery can not complete resection, therefore suggested oral molecules in patients with targeted drug imatinib mesylate treatment, regular follow-up to 2016 this year, the physical condition of patients, recurrence and metastasis the lesion was significantly reduced. The author through a lot of literature at home and abroad, a total of 5 reported cases of gastrointestinal stromal tumor with lung metastasis patients, the 5 patients with an average age of 53.4 years, 4 male patients and 1 female patients. Exploration of examination and preoperative imaging can accurately determine the tumor size, tumor growth and metastasis. Among them, three patients underwent complete resection, two patients diagnosed after full acceptance of the drugs. The reported 5 cases of gastrointestinal stromal tumor with lung the transfer of patients, metastasis were associated with other distant organs, two cases was 5 years and 10 years respectively after surgery found pulmonary metastasis, the remaining 3 cases were first diagnosed when they have been found to have lung metastasis. The pathological and immunohistochemical examination is the gold standard for diagnosis of gastrointestinal stromal tumors, 5 cases of this patients with pathological immunohistochemistry to examine the expression of CD117 was positive in 3 cases, the positive expression of CD34,.5 patients were diagnosed after received imatinib mesylate treatment after diagnosis were followed up for 5 years to 10 years, the clinical symptoms of the patients have to part Divided into remission. Conclusion: Patients with gastrointestinal stromal tumor pulmonary metastasis in clinic is very rare and atypical clinical symptoms, comparative review of clinical biological behavior, it is difficult to accurately predict benign and potential malignant tumor can recurrence and metastasis, the diagnosis mainly depends on imaging, pathological examination and immunohistochemistry after surgery. A first diagnosis of abdominal cavity and lung metastasis patients, usually late in the course of the disease the best time, without surgery, but after diagnosis given the whole molecular targeted drug imatinib therapy, can alleviate the quality of life and improve the prognosis of patients.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

【参考文献】