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116例胃肠道间质瘤 的临床特点、MRI影 像表现及病理分析

作者:金红花1 杨鹏平2

所属单位:1.武汉科技大学附属天佑医院放射 科 (湖北 武汉 430064) 2.武汉科技大学附属天佑医院急诊 科 (湖北 武汉 430064)

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摘要

目的 探讨胃肠道间质瘤的临 床、病理特点及MRI影像表现。方法 收集 我院2011年1月至2016年7月收治的116例 胃肠道间质瘤患者作为研究对象进行回顾 性分析,患者均行MRI检查,以病理结果 为基准,总结患者临床特点及良性与恶性 肿瘤MRI影像表现的差异。结果 116例患 者中,14例为良性、29例为潜在恶性、73 例为恶性。CD117阳性表达为98.3%、CD34 阳性表达率为59.0%。14例良性病灶平扫 示信号均匀22例,73例恶性患者信号不 均,潜在恶性患者信号可均匀或不均匀。 增强扫描良性多为均匀中等强化,恶性为 不均匀强化。结论 GIST多见于50岁以上 人群,患者多出现腹部胀痛不适、呕血与 黑便等消化道出血症状,良性瘤病理表现 为少见囊性变、出血、坏死,难见核分裂 象;潜在恶性瘤可见囊性变或出血,但无 肿瘤性坏死;恶性瘤可见囊性变、出血 外、肿瘤性坏死,部分肌层浸润、血管浸 润,核分裂象多在10个/50HPF以上。良性 瘤的MRI平扫多为均匀信号;恶性为不均 匀信号,增强扫描呈不均匀强化。

Objective To investigate the clinical and pathological features and MRI findings of gastrointestinal stromal tumors. Methods A total of 116 cases with gastrointestinal stromal tumors admitted in our hospital between January 2011 and July 2016 were selected as the study subjects and analyzed retrospectively. All patients underwent MRI examination. Based on the pathological results, the clinical features and differences in MRI findings between benign and malignant tumors were summarized. Results Among the 116 cases, 14 cases were benign, 29 were potential malignant, and 73 were malignant. The positive expression rate of CD117 was 98.3% and of CD34 was 59.0%. For 14 cases with benign lesions, plain scan of 22 cases showed homogeneous signal while plain scan of 73 cases with malignant tumors showed inhomogeneous signal. Patients with potential malignant tumors showed both homogeneous and inhomogeneous signal. The enhanced scan of benign tumors showed homogeneous and moderate enhancement while of the malignant ones showed inhomogeneous enhancement. Conclusion GIST is more common in population over 50 years old. Most of the patients have abdominal distension and pain, hematemesis, melena and other gastrointestinal bleeding symptoms. The pathological finding of benign tumors is little cystic degeneration, hemorrhage, necrosis and rare nuclear fission; Potential malignant tumors show cystic degeneration or hemorrhage, without tumor necrosis. Malignant tumor show cystic degeneration, hemorrhage, tumor necrosis, partial muscle invasion, blood vessel infiltration and nuclear fission more than 10 /50HPF. The MRI plain scan of benign tumors shows more homogeneous signal while of malignant tumors shows inhomogeneous signal. The enhanced scan shows inhomogeneous enhancement.

【关键词】胃肠道间质瘤;临床特点; MRI;影像表现

【中图分类号】R472.9+1

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.12.031

前言

胃肠道间质瘤(gastrointestinal stromal tumor,GIST)为起源 于间叶组织、细胞呈梭形或上皮样且CD117免疫组化呈阳性的肿瘤,有 时亦发生于肠系膜、腹膜后、盆腔等胃肠道外。GIST为近年分子生物 学技术及免疫组化技术不断进步所提出的病理学新概念[1],以往临床 多诊断为神经源性肿瘤或平滑肌源性。GIST有着恶性潜能,随瘤体增 大逐渐显现恶性生物学行为,对其进行准确良恶性判断极为重要。本 研究以我院收治的胃肠道间质瘤患者为例,对胃肠道间质瘤的临床特 点及MRI影像表现进行总结,以期提高临床对GIST的认识,现报道如 下。