什么是胃肠间质瘤？良性还是恶性？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">专家简介：冯强，协和医科大学肿瘤外科博士，医科院肿瘤医院结直肠外科<span style="color: black;">专家</span>医师，硕士<span style="color: black;">科研</span>生导师。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">说起“肿瘤”，想必<span style="color: black;">大众</span>都不会陌生。今天这篇<span style="color: black;">文案</span>要讲述的，<span style="color: black;">便是</span>一种叫做“胃肠间质瘤”的肿瘤。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃肠间质瘤(GIST)是胃肠道最<span style="color: black;">平常</span>的一类起源于胃肠道间叶组织的肿瘤。此处<span style="color: black;">说到</span>的“间叶组织”是组织学和病理学上的一个术语，指的是胚胎<span style="color: black;">生长</span>时，由中胚层的间充质分化<span style="color: black;">生长</span>来的组织的统<span style="color: black;">叫作</span>，例如结缔组织、脂肪组织、脉管组织、骨及软骨组织、黏液组织、淋巴造血组织、横纹肌及平滑肌组织、滑膜等均属于间叶组织。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃肠间质瘤在分化上与胃肠道肌间神经丛<span style="color: black;">周边</span>的Cajal间质细胞<span style="color: black;">类似</span>，在免疫组化上<span style="color: black;">一般</span>呈CD117、DOG-1标志物表达阳性，在组织学上由梭形细胞、上皮样细胞和偶尔的多形性细胞<span style="color: black;">摆列</span>成束状或弥漫分布。GIST<span style="color: black;">都数</span>由突变的c-kit或PDGFRA（血小板源性生长因子受体）基因驱动，c-kit与PDGFRA均属于型受体偶联的酪氨酸激酶家族。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-5f4d5b6a04b049cb635467c2ee50aa37_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">认识</span>了胃肠间质瘤的定义，<span style="color: black;">那样</span>，胃肠道间质瘤有什么临床表现呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">首要</span>要说的是，临床表现和肿瘤的大小、生长部位和方式<span style="color: black;">相关</span>，<span style="color: black;">一般</span><span style="color: black;">状况</span>下，<span style="color: black;">少于</span>5cm的间质瘤临床表现不<span style="color: black;">显著</span>。<span style="color: black;">按照</span>生长部位<span style="color: black;">区别</span>，可有如下表现：胃间质瘤<span style="color: black;">仅有</span>长到<span style="color: black;">必定</span>程度才会<span style="color: black;">导致</span>腹胀、<span style="color: black;">摄食</span>困难，否则很难<span style="color: black;">发掘</span>，但<span style="color: black;">倘若</span>肿瘤溃烂<span style="color: black;">引起</span><span style="color: black;">流血</span>，<span style="color: black;">显现</span>黑便或呕血等症状，做胃镜<span style="color: black;">能够</span><span style="color: black;">发掘</span>。食管间质瘤<span style="color: black;">发掘</span>的<span style="color: black;">重点</span><span style="color: black;">原由</span>是<span style="color: black;">摄食</span>哽噎困难，就诊时做胃镜或胸部CT<span style="color: black;">发掘</span>食管占位。小肠间质瘤的临床表现<span style="color: black;">重点</span>与肿瘤<span style="color: black;">是不是</span><span style="color: black;">引起</span>肠梗阻<span style="color: black;">相关</span>，<span style="color: black;">非常多</span>小肠间质瘤是<span style="color: black;">因为</span><span style="color: black;">显现</span>了肠梗阻的表现如腹痛、腹胀、停止排气、排便等，就诊时做腹部超声或腹盆CT<span style="color: black;">发掘</span>腹腔占位。<span style="color: black;">是不是</span><span style="color: black;">引起</span>梗阻，不仅与<span style="color: black;">体积</span><span style="color: black;">相关</span>，还与肿瘤生长方式<span style="color: black;">相关</span>系，肿瘤起源于小肠壁，<span style="color: black;">倘若</span>是腔内生长，2-3cm就<span style="color: black;">能够</span><span style="color: black;">引起</span>梗阻，<span style="color: black;">倘若</span>是腔外生长，可能10cm还<span style="color: black;">无</span>典型的梗阻表现，但<span style="color: black;">常常</span>会有<span style="color: black;">显著</span>的腹部包块，<span style="color: black;">能够</span>腹部触及，<span style="color: black;">乃至</span>有活动性。<span style="color: black;">倘若</span>肿瘤生长过快使血供不足致黏膜缺血、糜烂、溃疡、中心坏死，破溃于肠腔，<span style="color: black;">导致</span>肠道<span style="color: black;">流血</span>，<span style="color: black;">倘若</span>破裂入腹腔<span style="color: black;">导致</span>腹腔<span style="color: black;">海量</span><span style="color: black;">流血</span>。直肠间质瘤:比较容易<span style="color: black;">初期</span><span style="color: black;">发掘</span>，<span style="color: black;">重点</span>症状<span style="color: black;">便是</span>排便困难，<span style="color: black;">少许</span><span style="color: black;">病人</span>会有<span style="color: black;">流血</span>表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胃肠道间质瘤好发年龄为50岁以上，儿童罕见，男女发病率<span style="color: black;">没</span><span style="color: black;">显著</span>差异。GIST占胃肠道恶性肿瘤的1～3%，易<span style="color: black;">出现</span>肝脏和腹膜转移。<span style="color: black;">因此呢</span>，GIST的良、恶性是<span style="color: black;">病人</span>及其家属都<span style="color: black;">非常</span>关心的问题，<span style="color: black;">那样</span>该<span style="color: black;">怎样</span>判断呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">事实上，胃肠道间质瘤<span style="color: black;">不可</span>简单地判定为良性或是恶性。<span style="color: black;">短期</span>看，GIST 像是良性的，但随着时间的推移，几乎所有的 GIST 都会<span style="color: black;">显现</span>恶性<span style="color: black;">行径</span>，如<span style="color: black;">持续</span>变大、<span style="color: black;">出现</span>转移、术后复发等。<span style="color: black;">因此呢</span>，<span style="color: black;">能够</span>认为 GIST 是<span style="color: black;">拥有</span>恶性潜能的肿瘤，其恶性潜能的高低由肿瘤<span style="color: black;">体积</span>、部位和病理结果来决定。恶性潜能越高，致死可能越大。其恶性度<span style="color: black;">评定</span>如下图：</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-862d1e58dd01c9aee965246d5cacbca3_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最后，GIST该<span style="color: black;">怎样</span>治疗呢？GIST的治疗分为手术治疗和</p>
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