Gastrointestinal Stromal Tumors With Pulmonary Metastasis Single Case Report And Literature Review

[OBJECTIVE]:Gastrointestinal stromal tumors(GIST)is a common mesophyll-derived solid tumors of digestive system,liver and peritoneal metastasis is the main metastatic site,the occurrence of lung metastasis in the clinical is rare of.In this paper,by analyzing the case data of small intestine interstitial tumor with lung metastasis and the related literature at home and abroad to explore the clinical manifestations,diagnosis,treatment and prognosis,of gastrointestinal stromal tumor with lung metastasis,and to guide clinical treatment.[METHODS]:Through the analysis of the clinical data of a small intestine interstitial tumor with pulmonary metastasis in Acute Abdomen Surgery of the First Affiliated Hospital of Dalian Medical University and combine with the clinical data of 5 patients with gastrointestinal stromal tumors with lung metastases reported in related literatures to analyze the clinical data of the clinical features,imaging findings,pathology and immunohistochemical features,treatment and prognosis of gastrointestinal stromal tumors with pulmonary metastasis[RESULT]:The hospital admitted to a case of small intestine interstitial tumor with lung metastases,after improving the relevant auxiliary examination,the patient’s clinical diagnosis was small intestine tumors.Intraoperative see intracranial tumor solid,capsule integrity,size 15 x 15cm,incision swelling material white,tumor located in the small intestine wall,about 20cm from the cecum,distal small intestine and colon visible large amounts of blood,10cm small part of the small intestine resection(including tumor).Intraoperative diagnosis of small intestinal stromal tumors with bleeding.Postoperative pathological return:small intestine stromal tumors(high risk),both sides of the intestine margin of surgery were negative.Postoperative immunohistochemical results were:CD117(+),CD34(-).Postoperative patients recovered well,it is recommended that patients with oral molecular targeted drug imatinib mesylate for adjuvant therapy,but patients and their families refused to drug adjuvant therapy because of economic reasons.The patient is asked after every six months to review the hospital once,after the first four years,because of abdominal discomfort with hemoptysis the patient admitted to hospital again,considered small intestinal stromal tumor recurrence with lung and liver transfer after review the chest and abdominal CT and abdominal CT.The patient with lung metastases,and the recurrence of large tumors,surgery can not completely removed,it is recommended that the patient to take orally molecular targeted drug imatinib mesylate for treatment,and regular follow-up.Follow-up since 2016,The patient is in good physical condition,recurrence and metastasis was significantly reduced.Through a lot of access to literature.A total of 5 cases of gastrointestinal stromal tumors with lung metastases were reported at home and abroad.The average age of these five patients was 53.4 years old,with 4 male patients and 1 female patient.Preoperative imaging and intraoperative exploration can more accurately determine tumor size,invasive growth and distant metastasis.Of these,three patients after diagnosis underwent complete surgical resection,two patients diagnosed after receiving the full medical treatment.Reported in the five cases of gastrointestinal stromal tumors with lung metastases are accompanied by other distant organ metastasis,two cases were 5 years and 10 years after surgery were found distant lung metastasis,the remaining 3 when first diagnosed cases have been found to have lung metastases.Pathology and immunohistochemistry are the gold standard for the diagnosis of gastrointestinal stromal tumors.The expression of CD 117 in 5 cases is positive,and 3 cases of CD34 are positive.Five patients were diagnosed with molecular targeted drug imatinib treatment,were diagnosed after follow-up of 5 years to 10 years,the clinical symptoms of patients have been partially alleviated.[CONCLUSIONS]:Gastrointestinal stromal tumors in patients with lung metastasis in the clinical is very rare,clinical symptoms are not typical,biological behavior is more complex,it is difficult to accurately predict in clinical,benign and potentially malignant tumors can also relapse and metastasis,the main diagnosis Rely on imaging,postoperative pathology and immunohistochemistry.The first diagnosis of intra-abdominal and lung metastases,usually the course late,lost the best timing of surgery,but after diagnosis given full molecular targeted drugs imatinib therapy can relieve prognosis and quality of life.