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輔仁醫學期刊

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篇名 Jejunal Gastrointestinal Stromal Tumors with Liver Metastasis: Report of a Case
卷期 4:2
並列篇名 空腸的腸胃道基質瘤合併肝臟轉移--病例報告
作者 邱榮彬李嘉龍黃世鴻吳啟華陳德芳
頁次 99-106
關鍵字 腸胃道基質瘤肝臟轉移預後因子Gastrointestinal stromal tumorGISTCD-117Liver metastasisPrognostic factorImatinib mesylate
出刊日期 200606

中文摘要

腸胃道基質瘤(GIST)被認為是源自腸胃道的間質性腫瘤。臨床上病患通常以腹部不適,可觸摸到腫塊,或是消化道出血表現。大約70%的腫瘤在胃被發現,20-30%的腫瘤出現在小腸,小於10%在其他腸胃部位,偶爾會在腹膜,網膜的地方被找到。腸胃道基質瘤最常見的轉移部位是肝臟,我們提出一個病例是一位五十三歲的女性,她最初是以解黑便為臨床表現合併腹脹的原因到醫院求診,經檢查後發現是空腸的腸道基質腫瘤出血及合併肝臟轉移情形。腫瘤的大小及細胞分裂指數為最常用的預後評估因子,例如腫瘤大小直徑大於五公分以及高有絲分裂指數(大於5/50HPF)為預後不良。腸胃道基質瘤的標的物(Target)治療是一項重要的突破也帶來相當的益處。

英文摘要

Gastrointestinal stromal tumors (GISTs), previously presumed to be of smoothmuscle origin,represent a distinct but heterogeneous group of neoplasms with respect to their molecular etiologyand cellular origin. Patients usually present with abdominal discomfort, a palpable mass, or GIbleeding. About 70% of tumors occur in the stomach, 20%~30% in the small intestine, and fewerthan 10% in other locations of the GI tract and occasionally in the peritoneum, omentum, andretroperitoneum. The liver is themost common organ of metastasis alongwith local recurrence andinvasion to the peritoneum. Lymph node metastasis is rare.We present a 53-year-old woman whohad a jejunal tumor with liver involvement initially showing tarry stool passage. In serial studies,GIST with livermetastasiswas the final diagnosis. Tumor size and themitotic index are the 2 mostfrequently used prognostic factors: a large tumor (> 5 cm) and a high mitotic index (> 5/50 highpowerfields) indicate a poor prognosis. A critical breakthrough was recently made in molecularlytargeted treatment and prognosis of GISTs. Imatinib mesylate (Gleevec) has been shown to havebenefits and encouraging progress.

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