Clinical Character Analysis Of 67 Cases With Gastrointestinal Strmal Tumors

Objective: To investigate the clinical features of gastrointestinal stromal tumor, improve early clinical diagnosis and treatment, and reduce misdiagnosis and missed diagnosis.Methods: Sixty-seven patients with GIST in our hospital from December 2003 to December 2010 who had gone through surgery and confirmed by pathology were retrospectively analyzed, which included clinical symptoms and signs, laboratories,histopathology and immunohistochemistry, imaging studies, endoscopic diagnosis, treatment and follow-up data, and differential diagnosis.Results:1.General information: Sixty-seven GIST patients who were surgically resected at the Second Affiliated Hospital of Dalian Medical University from december 2003 to december 2010 were included in this analysis. There were 35 males and 32 famales with age of 15-72 years old and 59 years old on average. Tumor locations: stomach 35 cases(52.24%), jejunum and ileum 13 cases(19.40%), duodenum 6 cases (8.96%), rectum 3 cases (4.48%), colon 3 cases(4.48%), esophagus 3 cases(4.48%). 4 cases were not found in gastrointestinal tract(1 case in back peritoneum, 2 cases in peritoneum, 1 case in mesentery). including 2 cases of stromal tumors.2.Clinical presentation: The common clinical symptoms were abdominal discomfort (abdominal pain,bloating) in 22 patients(33.80%), followed by gastrointestinal bleeding (such as haematemesis melena) in 19 patients (28.17%), abdominal mass in 14 patients (21.23%), changes in bowel habit in 3 patients(4.23%), progressive dysphagia in 3 Patients(4.23%), 6 patients without any symptoms, 6 patients were found during physical examination or other diseases.Signs:Twenty-three cases with abdominal tenderness, palpable abdominal mass in 12 patients with the maximum mass diameter of 15cm, abnormality of rectal examination in 3 patients, and 31 patients without any positive signs.3.Lab Examination:hemoglobin decreased in 30 cases, 20 patients fecal occult blood test were positive, abnormal tumor markers in 3 cases, 18 cases with total protein and albumin abnormalities.4.Endoscopic Examination: Forty-one out of 67 patients went through endoscopy among which 3 cases were found tumor in duodenum, 3 cases in esophagus, gastric tumor in 35 cases, including 2 cases of stromal tumors, 4 cases of gastric cancer, 6 cases gastritis, 23 cases with endoscopic submucosal tumor. Of which 18 cases were considered of gastric leiomyoma. Under the endoscope, benign GIST is characteristic of hemispherical bulge, clear boundary, smooth surface, some with erosion of ulceration, while the malignant GIST is featured of the large diameter,irregular cavity and deep ulcer. 41patients underwent surgery and confirmed diagnosis with GIST, 13 cases were benign, borderline 8cases, malignant 20 cases. 6 cases of colorectal stromal tumor, 2 cases with endoscopic submucosal tumor, went through colonoscopy with biopsy, 4cases found during rectal exam and CT scan.5.CT Examination: Of the 67 patients, 51 were examed by CT scan,and the locations of tumors were as follows: 2 in the hepatic region, 1 between stomach and pancreas, 2 between spleen and stomach, 8 in the pelvic cavity, 14 in abdominal cavity, 14 in gastric region, 3 in duodenal region, 1 in jejunal, 1 between jejunal and pancreatic tail, 1 between liver and duodenal region, 1 in the colon region, 3 in the esophageal area. 27 of 51 patients were suspected as GIST by CT image.6. Histopathology and immunohistochemistry: The median diameter of tumor was 8cm,ranged from 1.5 - 30cm. microscopic morphology of cancer cell, included spindle cell type 45 cases, 4 cases with the epithelial cells, 18 cases with other cell types. Immunohistochemical staining showed the positive rate of the CD117, CD34,SMA, S-100 , Ki-67 were 95.52%, 74.63%, 14.93%, 8.96%, 67.16%respectively. According to criteria of diagnostic international GIST conference in 2004, 22 cases benign, 8 cases bonderline and malignant in 37 cases.7. Follow-up: 67 patients underwent surgery and diagnosed as GIST by pathology follow up 2-77 months. 10 cases failed to follow-up. Other causes of death in 6 patients recurrence in 15 cases, 36 cases had not been found recurrence.Conclusion:1.GIST the clinical manifestations and serological examination are unspecific. 2.While the combination of imaging studies and endoscopic examination are the main methods for preoperative diagnosis of the disease. And histopathology especially immunohistochemical phenotype is still needed to confirm diagnosis to reduce misdiagnosis and missed diagnosis.