Clinical Features And Misdiagnosis Factors Of Small Intestinal Stromal Tumors

BackgroundGastrointestinal stromal tumor(Gastrointestinal stromal,tumor,GIST)is a kind of originated from gastrointestinal mesenchymal tumors histologically with spindle cells and epithelioid cells,occasionally pleomorphic cells,is fascicular,diffuse arrangement;the expression of c-kit gene protein product CD117 immune phenotype.From the immature mesenchymal cells to interstitial cells of Cajal(interstitial cell of Cajal,ICC)differentiation,diagnosis often confused with leiomyoma and nerve sheath tumor and other diseases.The incidence of the disease is relatively low,only 1% of the primary tumors in the digestive tract.Most of the GIST in the stomach,accounting for about second of the total number of 50-65%,the small intestine is the GIST of the predilection site.In small bowel stromal tumors called intestinal stromal tumor(Small intestine stromal tumors,SIST),accounting for about GIST 20%-35%,because of its low incidence,clinical symptoms,anatomical site early occult atypical,prone to misdiagnosis clinically misdiagnosed as gynecologic tumor and leiomyoma of digestive tract diseases.The development of medical technology makes the biological behavior of GIST by people gradually understand and are familiar with,but the misdiagnosis factors of SIST at home and abroad studies related literature shows that domestic SIST incidence increased year by year,so to explore the clinical characteristics and misdiagnosis factors have important significance to reduce the misdiagnosis rate.ObjectiveThis study retrospectively analyzed the clinical data of SIST patients through the use of statistical concepts and methods,the clinical characteristics and misdiagnosis caused by factors of SIST,to improve the level of diagnosis and treatment,reduce the incidence of misdiagnosis.MethodsIn this study,104 patients with SIST who were hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2010 to January 2015 were collected.All patients were diagnosed as SIST.Retrospective analysis of clinical data of clinical manifestation,tumor location,tumor size,growth pattern,inspection methods,all patients were divided into group diagnosis and misdiagnosis group for statistical description,application SPSS19.0 statistical software for data analysis,analysis of different factors in the SIST misdiagnosis.The measurement data described by mean + SD,the two groups were compared using independent samples t test,will be included in the two classification Logistic regression model to analyze the influencing factors of SIST misdiagnosis,the relationship between each variable and the risk evaluation of misdiagnosis.P<0.05 was statistically significant.ResultsThe incidence of SIST sites in the jejunum is more common,accounting for 45.2%,followed by the ileum(29.8%),duodenum(25%);the clinical symptoms were abdominal mass in 67 cases(64.5%),47 cases of gastrointestinal bleeding(52.8%),abdominal pain in 47 cases(52.8%);extraluminal growth mode of the most common tumors;the diameter of less than 10 cm accounted for 87 cases(83.6%),which is less than 5cm accounted for 49 cases;digestive endoscopy plays an important role in the diagnosis,ultrasound is the most prone to misdiagnosis;metastasis mainly in the liver,a peritoneum,lymph node,bone metastasis.In this study,the misdiagnosis rate of the disease is as high as 34.6%,which is easy to be misdiagnosed as gynecological tumors(15/36),gastrointestinal leiomyoma(3/36)and other diseases.ConclusionsSIST is mainly in the jejunum and abdominal mass,gastrointestinal bleeding is a common clinical manifestation of gastrointestinal stromal tumors,the clinical misdiagnosis rate is high,the incidence of misdiagnosis by clinical manifestations,tumor location,tumor size,growth pattern,inspection methods and other factors.For color Doppler ultrasound,CT,ordinary gastrointestinal endoscopy,such as repeated examination can not be clearly diagnosed in patients with persistent gastrointestinal bleeding,abdominal mass,abdominal pain in patients with long-term should be a small bowel endoscopy or capsule endoscopy.As early as possible biopsy and immunohistochemical examination for early diagnosis,to avoid misdiagnosis.