胃肠间质瘤合并肺动脉主干占位病例1例并文献复习  

Multiple metastases of gastrointestinal stromal tumor complicated with main pulmonary artery embolism: a case report and literature review

作　　者：龙要梅 李昌敏 资源 张明慧 毛樟坤 刘俊永 LONG Yaomei;LI Changmin;ZI Yuan;ZHANG Minghui;MAO Zhangkun;LIU Junyong(Department of Basic Medical Science,Xiangnan University,Hunan Province,Chenzhou423000,China;Department of gastrointestinal surgery,the First People's Hospital of Chenzhou,Hunan Province,Chenzhou423000,China;Department of Respiratory and Critical Care Medicine,the First People's Hospital of Chenzhou,Hunan Province,Chenzhou423000,China)

机构地区：[1]湘南学院基础医学院,湖南郴州423000 [2]湖南省郴州市第一人民医院胃肠外科,湖南郴州423000 [3]湖南省郴州市第一人民医院呼吸与危重症医学科,湖南郴州423000

出　　处：《中国当代医药》2024年第27期147-150,共4页China Modern Medicine

基　　金：湖南省郴州科技计划临床医疗技术研究项目(lcyl2021061);湖南省大学生创新创业训练计划项目(教通[2023]237号,序号3720);湖南省郴州市第一人民医院院内新技术项目(2020A17);湘南学院大学生创新创业项目[2022(78号),序号96]。

摘　　要：胃肠道间质瘤(GIST)起病隐匿,多数患者在确诊时已出现远处转移,常见转移部位为肝脏和腹膜,骨转移和肺转移较罕见。回顾性收集2022年4月郴州第一人民医院1例GIST多发转移合并肺动脉主干栓塞患者的临床资料,其因咳嗽、胸闷入院,辅助检查发现肺动脉主干栓塞、盆腔巨大肿块,腹腔肿块穿刺活检提示梭形细胞瘤,免疫组化可见CD117(+)、CD34(+)、Dog-1(+),治疗上该患者予以酪氨酸激酶抑制剂(TKIs)甲磺酸伊马替尼(IM)靶向治疗,并予低分子肝素及华法林抗凝治疗后患者病情平稳。通过对此病例介绍及文献复习,得出GIST合并肺动脉栓塞的病例少见,对于此类患者其栓塞无论为瘤栓还是血栓,抗凝治疗均可减轻瘤负荷和缓解栓塞,临床实践中多采取包括手术、介入、化学药物治疗、靶向治疗等综合模式,期望为今后GIST的治疗提供参考以争取更好的临床预后。Gastrointestinal stromal tumor(GIST)have an insidious onset,and most patients have distant metastases at the time of diagnosis.The common metastatic sites are liver and peritoneum,while bone and lung metastases are rare.A patient with multiple metastasis of GIST complicated with main pulmonary artery embolism was admitted to the First People's Hospital of Chenzhou in April 2022.The patient was hospitalized due to cough and chest tightness.The patient was found to have main pulmonary artery embolism and a huge pelvic mass by assisted examination,and the puncture biopsy of abdominal mass revealed spindle cell tumor.Immunohistochemistry showed CD117(+),CD34(+)and Dog-1(+).The patient was treated with tyrosine kinase inhibitor(TKIs)imatinib mesylate(IM),and patient's condition was stable after anti-coagulation therapy with low molecular weight heparin and warfarin.Through this case introduction and literature review,it is concluded that pulmonary embolism is rare in GIST patients.For these patients,no matter the embolism is tumor embolism or thrombus,anticoagulation therapy can reduce tumor load and relieve embolism.In clinical practice,comprehensive modes including surgery,intervention,chemical therapy and targeted therapy are usually adopted.It is expected to provide reference for future treatment of GIST to strive for better clinical prognosis.

关 键 词：胃肠间质瘤 肺动脉栓塞 转移 免疫组化 梭形细胞瘤 

分 类 号：R735[医药卫生—肿瘤] R542.5[医药卫生—临床医学]