巨大胃肠间质瘤经MDT讨论新辅助治疗后的手术一例及文献复习

doi:10.3877/cma.j.issn.1674-0785.2023.03.022

中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 360 -363. doi: 10.3877/cma.j.issn.1674-0785.2023.03.022

临床病例研究

巨大胃肠间质瘤经MDT讨论新辅助治疗后的手术一例及文献复习

孔飞, 唐发兵, 魏琼, 范珊琳, 袁文臻^†(

)

730030　甘肃兰州，兰州大学第一临床医学院
730030　兰州大学第一医院病理科
730030　兰州大学第一医院医务处MDT办公室
730030　兰州大学第一医院肿瘤外科

收稿日期:2022-09-22 出版日期:2023-03-15
通信作者: 袁文臻

Surgical treamtent of giant gastrointestinal mesenchymal tumor after neoadjuvant therapy: a case report and review of the literature

Fei Kong, Fabing Tang, Qiong Wei, Shanlin Fan, Wenzhen Yuan^†()

Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou 256600, China
Department of Pathology, The First Hospital of Lanzhou University, Lanzhou 730030, China
Medical Department MDT Office, The First Hospital of Lanzhou University, Lanzhou 730030, China
Department of Oncology, The First Hospital of Lanzhou University, Lanzhou 730030, China

Received:2022-09-22 Published:2023-03-15
Corresponding author: Wenzhen Yuan

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目的

报告巨大胃肠间质瘤新辅助治疗后的手术切除1例及文献复习，探讨甲磺酸伊马替尼术前治疗巨大胃肠间质瘤的最佳手术时机。

方法

报告1例巨大胃肠间质瘤的诊疗过程并进行文献复习。

结果

本例患者为47岁女性，以腹部包块、腹痛、腹胀为主要表现，通过CT、穿刺活检等诊断为胃肠恶性间质瘤。初诊肿瘤最大径上下约233 mm×前后117 mm×左右213 mm，多学科讨论认为无法切除R0，依据基因检测结果，予以甲磺酸伊马替尼400 mg/d行术前新辅助治疗。6月后患者肿瘤明显缩小，予以R0切除，组织病理学检查结果为：胃大弯侧间质瘤。术后随访至今，未见复发转移。

结论

对于初诊无法切除的巨大胃肠间质瘤患者，可选择在分子靶向药物治疗达到最大效益时进行手术，提高R0的切除率

Objective

To report a case of giant gastrointestinal mesenchymal tumor treated by surgical resection after neoadjuvant therapy, and to investigate the optimal timing of surgery for giant gastrointestinal mesenchymal tumor preoperatively treated with imatinib mesylate by reviewing the relevant literature.

Methods

A case of giant gastrointestinal mesenchymal tumor is reported and the relevant literature is reviewed.

Results

A 47-year-old woman presented with abdominal mass, abdominal pain, and abdominal distension, and she was diagnosed as having malignant gastrointestinal malignant mesenchymal tumor by CT and puncture biopsy. The maximum diameter of the tumor was about 233 mm × 117 mm × 213 mm at the initial diagnosis. No recurrence of metastasis was observed in the postoperative follow-up to date.

Conclusion

For patients with initially unresectable giant gastrointestinal mesenchymal tumor, surgery can be chosen when the maximum benefit of molecular targeted drug therapy is achieved to improve the R0 resection rate.

Key words: Giant gastrointestinal mesenchymal tumor, MDT discussion, Neoadjuvant therapy, Literature review

图1 患者首诊时的腹腔穿刺活检病理图。图a为梭形肿瘤细胞呈束状排列，局部间质粘液变性（HE，200倍）；图b为梭形肿瘤细胞呈束状排列，疏密不等，局部水肿（HE，200倍）。

图2 治疗过程中CT变化。图a、b为患者初次就诊时CT见腹腔巨大占位；图c、d为治疗2个月时CT肿物缩小，疗效评估为部分缓解；图e、f为治疗4个月时肿物进一步缩小，疗效评估为稳定；图g、h为治疗5个月时肿物继续缩小，疗效评估为稳定；图i、j为治疗6个月时肿物较前一次变化不大，疗效评估为稳定

图3 示手术标本以及术后病理学检查结果。图a、b、c为术后标本大体形态；图d为患者术后HE染色结果（HE染色）

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