The Clinical Characteristics,Diagnosis And Treatment Of Hepatic Gastrointestinal Stromal Tumor

Objective: To investigate the clinical manifestations,imaging features,pathological features,treatment methods,and prognosis of hepatic gastrointestinal stromal tumors in order to raise awareness of the disease.Methods: Reported case data of a patient with hepatic gastrointestinal stromal tumor admitted to our hospital in August 2016.The data was retrieved from the CNKI database,Wanfang data knowledge service platform,and the Pubmed database from June 2000 to June 2017.Monthly reports on liver gastrointestinal stromal tumors were published in both Chinese and English.Their clinical manifestations were analyzed retrospectively,including imaging,pathological features,treatment and prognosis.Results: A male patient,74 years,was admitted to our hospital because of "epigastric pain and discomfort for 7 days".The results of laboratory tests were normal.Preoperative examination showed that the left extrahepatic lobe was observed to be space-occupying lesion.Improved the preoperative examination and left hemihepatectomy was performed.No tumor tissue was found in the gastrointestinal tract or abdominal organs during intraoperative exploration.Intraoperative frozen section considering the possibility of gastrointestinal stromal tumors was high.Postoperative pathological report:(Left hepatic lobe)Malignant gastrointestinal stromal tumor(Mixed cell type).Immunohistochemistry: tumor cell CD117(Local +),DOG1(+),CD34(+),Vimentin(+),AFP(-),CEA(-),S-100(-),Desmin(-),SMA(-),Ki-67(+,About 10%).In the retrospectively analyzed 15 cases,all patients were diagnosed by pathology,including 9 males and 6 females.The ratio of male to female was 1.5:1.The age of onset was 17-74 years old and the median age was 56 years.The clinical manifestations were not specific.The clinical symptoms can be manifested as upper abdominal discomfort,bloating,abdominal mass,loss of appetite,a small number of patients with dyspnea,nausea and other symptoms.No obvious abnormalities in laboratory tests,some patients may have abnormal liver function or tumor markers increased.Abdominal CT examination mainly showed round or round soft tissue mass shadows in the liver,with different sizes and uneven densities.The diagnosis mainly depended on immunohistochemical staining.The histological findings were spindle cells,epithelioid cells,and a mixture of the two types.The tumor cells were positive for CD117 and/or DOG1 and CD34 immunohistochemistry.At present,the most effective treatment is surgery.Patients with unresectable disease can be supplemented with interventional therapy,chemotherapy,radiotherapy,and molecular targeted drug therapy.The risk of recurrence and metastasis is high and the prognosis is higher than that of the stomach.Stromal tumors and small intestinal stromal tumors are poor.Conclusion: 1.The gastrointestinal stromal tumors of liver are rare,and are more common in middle-aged and older men,and about 50% are younger than 60 years old.2.The diagnosis of hepatic gastrointestinal stromal tumors mainly depends on pathological examination.Histology can be characterized by spindle cells,epithelioid cells,and a combination of the two types.The immunohistochemical staining is mainly characterized by positive staining of CD117 and/or DOG1 and CD34.3.The preferred treatment for hepatic gastrointestinal stromal tumors is surgery.For those who cannot tolerate surgery or cannot remove tumors,they can be assisted by interventional therapy,chemotherapy,radiotherapy,and molecular targeted drug therapy.The risk of recurrence and metastasis is high and the prognosis is higher than that of the stomach.Stromal tumors and small intestinal stromal tumors are poor.