The Analysis Of Clinical Diagnosis And Treatment For Small Intestine Gastrointestinal Stromal Tumor: A Review Of 67 Cases

ObjectiveTo summarize the clinical pathological characterics of the Gastrointestinal Stromal Tumors in small intestine, analyze the diagnostic value of different examination methods, and investigate treatment and prognosis factors.MethodsA retrospective analysis of clinical data of patients with pathologically confirmed small intestine Gastrointestinal Stromal Tumor from Jan.2013 to Dec.2015 was performed in the Second Affiliated Hospital of Zhejiang University College of Medicine.ResultsOf the 67 cases, the small intestine Gastrointestinal Stromal Tumor originated from jejunum in 41 cases(61.2%),duodenum and ileum each in 12 cases(17.9%),ileocecal region in 2 cases (2.99%).Most part of the patients(62/67) had clinical manifestation without specificity,such as gastrointestinal bleeding and abdominal distension or pain for common. Spiral CT has a higher diagnosis rate(93.99%) and diagnosis coincidence rate(76.67%) in various imaging and endoscope examinations. The biology risk of 67 cases were 1 case at extremely low risk(1.49%),27 cases at low risk(40.30%),6 cases at moderate risk(8.95%) and 33 cases at high risk(49.25%) and the spiral CT enhancement helps to preoperative assessment of the risk. Immunohistochemistry detection of CD117 and DOG-1 both have the highest positive expression, each for 97.33% and 100%.All cases when diagnosed for the first time had surgical treatment, while 1 case with neoadjuvant therapy of imatinib and 17 cases with postoperative imatinib adjuvant therapy.ConclusionSmall intestine Gastrointestinal Stromal Tumor lacks of characteristic clinical manifestations, and it occurs in jejunum for most. Endoscopy combined with CT imaging examination can effectively improved the detection rate and diagnosis coincidence rate while there is still no specific examination. Diagnosis depends on pathological morphology and immunohistochemistry with CD117 and DOG-1 positive expression. All small intestine Gastrointestinal Stromal Tumor shall be surgical treatment unless with some surgical contraindications. Neoadjuvant therapy for almost 6 months can achieve the best curative effect and the patients of moderate and high biological risk are recommend adjuvant therapy of imatinib.