Gastrointestinal Stromal Tumors and Other英文电子书.pdf

Gastrointestinal Stromal Tumors and Other Mesenchymal Lesions of the Gut Joel K. Greenson, M.D. Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan Although a great many mesenchymal lesions may be In the past 5 years, there has been a paradigm shift found in the gastrointestinal (GI) tract, none are more in our understanding of gastrointestinal stromal tu- vexing to the surgical pathologist than stromal tu- mors (GISTs). Once thought to be smooth muscle mors. In 1960, Martin and colleagues (1) published a tumors, these uncommon neoplasms are now series of six cases of “intramural myoid tumors” of the thought to differentiate along the lines of interstitial stomach and theorized that these unusual tumors cells of Cajal, the pacemaker cells of the gut. Along were of smooth muscle origin. Two years later, Stout with this understanding comes an exciting new (2) introduced the term leiomyoblastoma to describe drug therapy (Gleevec) that for the first time offers a group of bizarre smooth muscle tumors of the stom- real hope to patients with malignant stromal tu- ach. Since that time, a wide variety of names have mors. Overall, approximately 60–70% of stromal been used to describe these spindle and epithelioid tumors are from the stomach, 20–30% are from the cell tumors that may arise anywhere along the GI tract small intestine, and 10% come from the esopha- as well as in the omentum and mesentery. In 1983, gus, colon, rectum, omentum, and mesentery. Be- Mazur and Clark (3) first used the term stromal tumor tween 10 and 30% of GISTs are malignant. Stromal to describe