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目的探讨空肠间质瘤的临床表现、病理免疫绀化特征、多层螺旋CT(MSCT)和血管造影三维CT成像(3D-MSCTA)特征、治疗方法及预后。方法对2003年至2006年收治的21例空肠间质瘤患者进行胃十二指肠、结肠镜、MSCT、及3D-MSCTA检查。21例患者均经手术切除空肠肿瘤。其中18例行肿瘤完整切除,3例行空肠肿瘤姑息性切除.有3例术后接受伊马替尼治疗。对手术切除标本行常规镜检及病理学诊断.同时采用EnVision二步法进行免疫组化染色,检测酪氨酸激酶受体(CD117)、造血干细胞抗原(CD34)、肌动蛋白、肌间线蛋白、可溶性酸性蛋白(S-100)、波形蛋白的表达。结果21例空肠间质瘤中.4例良性.6例呈交界性.11例为恶性。其中17例以消化道出血就诊.以反复黑便、头晕、贫血等慢性失血症状为主,7例伴腹部隐痛,11例有严重贫血。3例以腹部肿块就诊,2例以恶心、呕吐等肠梗阻症状就诊。肿瘤同时向腔内、外生长5例.向腔外生长16例。10例良性或交界性肿瘤的瘤细胞以梭形细胞为主。11例恶性肿瘤的瘤细胞以上皮细胞为主。免疫组化检查波形蛋白呈弥漫性,阳性率为100%(21/21);CD117、CD34弥漫阳性表达,阳性率分别为95.2%(20/21)、85.7%(18/21);肌动蛋白3、S-100、肌间线蛋白阳性率分别为14.3%(3/21)、38.1%(8/21)、9.5%(2/21),呈散在或灶性阳性。MSCT平扫肿瘤均匀等密度者9例;肿块内密度不均伴大小不等、形态不一的低密度者8例;肿块周边呈等密度,中间呈略低密度或低密度者4例。3D-MSCTA中见肿瘤由肠系膜上、下动脉联合供血5例;肠系膜上动脉供血16例。结论对病程较长、不明原因的消化道出血患者应及早行MSCT检查,对可疑病例早期剖腹探查,同时行无残留性手术切除,并加用伊马替尼治疗。
Objective To investigate the clinical manifestations, pathological immunologic-chemical features, multi-slice spiral CT (MSCT) and three-dimensional angiography (3D-MSCTA) features of jejunum stromal tumors, treatment and prognosis. Methods Gastroduodenoscopy, colonoscopy, MSCT, and 3D-MSCTA were performed in 21 patients with jejunum stromal tumors from 2003 to 2006. All 21 patients underwent resection of jejunum tumor. Among them, 18 patients underwent complete resection of the tumor and 3 patients underwent palliative resection of the jejunum tumor, while 3 patients received imatinib treatment after operation. Surgical specimens were examined by routine microscopy and histopathology, and EnVision two-step immunohistochemical staining was performed to detect the expression of tyrosine kinase receptor (CD117), hematopoietic stem cell antigen (CD34), actin, Protein, soluble acidic protein (S-100), vimentin expression. Results In 21 cases of jejunal stromal tumors, 4 were benign, 6 were borderline, and 11 were malignant. Among them, 17 cases were treated with gastrointestinal bleeding, with the main symptoms of recurrent melena, dizziness, anemia and other chronic blood loss, 7 cases with abdominal pain and 11 cases with severe anemia. 3 cases were treated with abdominal mass and 2 cases were treated with symptoms of intestinal obstruction such as nausea and vomiting. Tumor at the same time to the lumen and outside growth in 5 cases to the extraluminal growth in 16 cases. Ten cases of benign or borderline tumor cells to spindle-based. 11 cases of malignant tumor cells to epithelial cells. Immunohistochemistry showed that the vimentin was diffuse, the positive rate was 100% (21/21); CD117 and CD34 were diffusely positive, the positive rates were 95.2% (20/21) and 85.7% (18/21) The positive rates of protein 3, S-100 and myosin were 14.3% (3/21), 38.1% (8/21) and 9.5% (2/21), respectively. MSCT scan uniform tumor density in 9 cases; uneven mass density with varying sizes, low density of 8 cases; mass was the same density around the middle was slightly lower density or low density in 4 cases. In the 3D-MSCTA, tumors were found in 5 cases by combining the superior and inferior mesenteric arteries with 16 cases of superior mesenteric artery blood supply. Conclusion Patients with longer duration and unknown cause of gastrointestinal bleeding should be treated with MSCT as early as possible. Early exploratory laparotomy should be performed on suspicious cases and no residual surgical resection should be performed concurrently with imatinib treatment.