Discrimination between gastric ectopic pancreas and mesenchymal tumours, including GIST – from 12 years‘ surgical experience in one institute

Y. OTANI, M. YOSHIDA, Y. SAIKAWA, N. WADA, T. KUBOTA, K. KUMAI, Y. SUGINO, M. MUKAI, K. KAMEYAMA, M. KITAJIMA
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引用次数: 13

Abstract

Summary

Background

Although recent immunochemical analysis enabled the discrimination of gastrointestinal stromal tumour (GIST) to other mesenchymal tumours, preoperative diagnosis of these tumours is not always easy.

Aim

To discriminate between ectopic pancreas (EP) and mesenchymal tumours, including GIST, 12 years surgical experience at Keio University Hospital was reviewed.

Methods

Clinicopathological findings were analysed for 131 patients with gastric submucosal tumours (SMT), including GIST (67 cases), myogenic tumour (21 cases), Schwannoma (11 cases), EP (12 cases) and others (20 cases) surgically treated at Keio University Hospital since 1993.

Results

Analysis of clinicopathological findings of these tumours showed that GIST, myogenic tumour and Schwannoma mimic each other from the standpoint of size and location of the tumour. In contrast, comparison of mesenchymal tumours showed that, compared with gastrointestinal mesenchymal tumour, EP tends to exist at middle or lower third of the stomach (P = 0.004), and the tumour size was smaller than 3 cm (P = 0.0006). All EPs were laparoscopically resected and no malignant features were evident.

Conclusion

To avoid unnecessary surgery for EP, SMT smaller than 3 cm occurring in the middle or lower third of the stomach should be carefully selected as a candidate of surgical resection.

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鉴别胃异位胰腺和间充质肿瘤,包括GIST -从一个研究所12年的手术经验
虽然最近的免疫化学分析能够区分胃肠道间质瘤(GIST)和其他间质肿瘤,但这些肿瘤的术前诊断并不总是容易的。目的总结庆应义塾大学附属医院12年手术经验,以鉴别异位胰腺(EP)与间充质肿瘤(包括GIST)。方法对1993年以来在庆应义塾大学医院手术治疗的131例胃粘膜下肿瘤(SMT)的临床病理表现进行分析,其中GIST(67例)、肌源性肿瘤(21例)、神经鞘瘤(11例)、EP(12例)及其他20例。结果经临床病理分析,胃肠道间质瘤、肌源性瘤和神经鞘瘤在肿瘤大小和位置上具有相似之处。而间充质肿瘤的比较显示,与胃肠道间充质肿瘤相比,EP倾向于存在于胃的中下三分之一(P = 0.004),肿瘤大小小于3 cm (P = 0.0006)。所有EPs均行腹腔镜切除,无明显恶性特征。结论为避免不必要的EP手术,应慎重选择胃中下三分之一处小于3cm的SMT作为手术切除的备选方案。
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