胃肠道间质瘤概念ppt课件.pptVIP

胃肠道间质瘤概念;发病率及发病部位 ;Sixty percent of GISTs present in the stomach, 30% in the small intestine, 5% in the colon and rectum and 5% in the oesophagus About 140 new cases are recognized in Greece every year; the mean age of diagnosis is 60 years and the male to female ratio approximately 1.4:1 [4]. ;GIST的症状、体征;The most frequent manifestations of the disease include gastrointestinal haemorrhage, fatigue due to chronic anaemia, loss of appetite, weight loss, vom-iting, the presence of a palpable mass, and non-spe-cific abdominal pain. These symptoms appear due to displacement, rather than infiltration of nearby structures. A combination of symptoms is present in over 5% of patients [6、7];病理诊断基因诊断;The expression ofCD34 is more frequent in gastric GISTs (85%), while it is positive in only 50% of GISTs that arise from the small intestine [10]. CD34 is universally expressed in oesophageal GISTs. Another recently recognized marker is cyclooxygenase 2 (COX-2) At least 80% of GISTs express this protein [11];病理图示;CT and EUS;GIST的治疗;GISTs have certain attributes that define the surgical management. First of all, GISTs metastasize to the liver and the peritoneal surfaces; however, the regional lymph nodes are spared. Furthermore, the stromal tumours expand extramurally. ;Also, GISTs tend to displace rather than infiltrate adjacent structures. Finally, GISTs are fragile tumours, and if they rupture during their manipulation, there is an increased risk of peritoneal seeding. It should also be noted that an intra-peritoneal rupture of GISTs is of the same prognostic significance as a non-R0 excision of the tumour [15]. ;those patients with metastatic or relapse of the disease, neoadjuvant therapy is often a prerequisite for an attempted R0 excision. As a matter of fact, these patients in the preimatinib era demonstrated a mean survival of 12 months [16].;药物治疗;A total response was recorded in 4-5% of these patients and a reduction in the size of the tumour ≥ 50% in 47-67% of these