尽管它们相对罕见,胃肠道间质瘤(GIST)是胃肠道(GI)中最常见的间质瘤。这里,我们描述了一例罕见的62岁高血压女性,表现为腹痛和明显的肿块,根据放射学发现,最初怀疑是胰腺假性囊肿。手术切除后的组织病理学(HPE)检查显示出源自胃的大的囊性病变。以恶性上皮样GIST为特征。根据这些发现并考虑到患者的症状,决定将病人提前邮寄,没有术前活检研究的开放式手术探查。考虑到鉴别诊断,冻结的科室设施处于待机状态。由于冷冻切片显示胃部GIST,决定进行胃大部切除术,其次是胃空肠吻合术(GJ)和空肠吻合术(JJ)。此外,通过非解剖楔形切除术处理了与肝左叶粘附的囊肿部分。免疫组织化学(IHC)分析显示分化簇117(CD117)阳性,分化簇34(CD34)阴性,Desmin,并发现胃肠道间质瘤1(DOG-1)。肿瘤表现出侵袭性特征,包括高有丝分裂活性,即,>5/10高功率场(hpf),出血区,并渗入肝实质.然后患者接受基于伊马替尼的辅助化疗,并保持严格的随访。
Despite their relative rarity, gastrointestinal stromal tumors (GIST) are the most common type of mesenchymal tumor in the gastrointestinal (GI) tract. Here, we describe a
rare case of a 62-year-old hypertensive female presenting with abdominal pain and a palpable mass, initially suspected to be a pancreatic pseudocyst based on radiological findings. Subsequent histopathological (HPE) examination following surgical resection revealed a large cystic lesion originating from the stomach, characterized as a malignant epithelioid GIST. Based on these findings and taking into consideration the symptomatology of the patient, the decision was made to post the patient for an upfront, open surgical exploration without pre-operative biopsy studies. Frozen section facilities were kept on standby considering the differential diagnosis. Since the frozen section revealed a gastric GIST, a decision was made to perform subtotal gastrectomy, followed by gastrojejunostomy (GJ) and jejunojejunostomy (JJ). In addition, the part of the cyst adherent to the left lobe of the liver was dealt with with a non-anatomical wedge resection. Immunohistochemical (IHC) analysis showed positivity for Cluster of Differentiation 117 (CD117) with negativity for Cluster of Differentiation 34 (CD34), Desmin, and Discovered On Gastrointestinal Stromal Tumors 1 (DOG-1). The tumor exhibited aggressive features, including high mitotic activity, i.e., >5/10 high power field (hpf), hemorrhagic areas, and infiltration into the liver parenchyma. The patient then received adjuvant imatinib-based chemotherapy and was maintained on strict follow-up.