小网膜间质瘤1例并文献复习

小网膜间质瘤1例并文献复习
标签：间质瘤; 小网膜
胃肠道间质瘤(GIST)少见,而原发于小网膜的间质瘤更为少见,我们收治1例,现并文献复习报道如下。

1 临床资料
患者,男,62岁,发现腹部肿物10d入院。

该患者于10d前体检过程中通过磁共振证实腹腔肿物,无发热,无腹痛、腹胀,无恶心、呕吐,排气、排便如常。

近期体重未见减轻。

查体:腹平坦,未见肠型及蠕动波,未触及肿物,全腹无压痛及肌紧张。

辅助检查:MRI:小网膜区可见囊实性占位病变,囊性部分呈T1WI低、T2WI高信号,实性部分大致呈等信号,范围约为3.2cm×2.2cm,部分边界不清;静注Gd-DTPA增强扫描后,小网膜区占位病变动脉期及门脉期未见强化,延迟期可见边缘明显结节状强化;印象诊断:小网膜区占位,考虑间叶组织源性肿瘤,见图1、2。

术前诊断:小网膜肿物,于入院后3d在全麻下行剖腹探查术,术中见小网膜近小弯处一大小约5cm×5cm×5cm球形肿物,包膜完整,与胰腺及胃小弯部分粘连,血运主要来自胃小弯血管分支。

探查腹腔内未见其他肿物。

术中切除肿物顺利。

术后病理回报:瘤组织由梭形细胞构成,编织状排列,核杆状,有异型性,核分裂(0-1)个/10HPF。

病理诊断:免疫组化:CD117(+),CD34(+),vimentin(+),SMA(-),ki67(+5/10HPF为恶性。

核分裂静止期上皮性肿瘤直径≥6㎝时为恶性[13]。

由于小网膜间质瘤较少发生,故其良恶性的判断标准尚未制定。

既往间质瘤的治疗以手术切除为主,化疗对间质瘤的治疗效果并不满意[14]。

近些年伊马替尼(酪氨酸激酶抑制剂)逐渐应用于间质瘤的化学治疗,并取得一定治疗效果[15]。

而对于发生于小网膜的间质瘤而言,手术切除是目前治疗的最有效方法。

发生于小网膜的间质瘤对化学治疗是否敏感,仍有待于进一步临床研究。

据报道,肿瘤大小、细胞结构、有丝分裂计数、组织学分型、远处转移、浸润程度和坏死程度等因素影响着胃肠道间质瘤的愈后[11]。

这些因素可能也同样影响小网膜间质瘤的愈后。

由于小网膜间质瘤较为少见,故对于其治疗及愈后相关因素尚无定论,有待于进一步临床研究证明。

[参考文献]
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(收稿日期:2010-02-26)。