GISTの臨床的対応―粘膜下腫瘍におけるGISTの頻度と臨床的取り扱い

Clinical Treatment of GIST-Incidence of GIST among Patients with Submucosal Tumors and Its Clinical Treatment

要旨　当施設におけるGISTの発見頻度とその臨床的取り扱いについて述べた．健診の胃造影検査受検者を対象とすると約0.3％にGIMT(gastrointestinal mesenchymal tumor)が発見される．GISTは現時点では病理診断名であり，臨床的にはGIMTと診断される．GIMT中に占めるGISTの頻度は70.7％，筋原性腫瘍が24.4％，神経原性腫瘍が4.9％であった．従来の筋原性腫瘍の病理学的悪性度診断指標でみるとGISTは良性と診断されたものの52.4％，悪性と診断されたものの90％を占めていた．GIMTの大きさ別GISTの頻度をみると，大きさに関係なく認められた．従来の筋原性腫瘍に適用されていた臨床的悪性度診断指標はGISTにも適用される．しかし，遺伝子学的研究などが進歩している現在，組織を採取し，正確な組織診断を行い，その上で臨床的対応を決定する方向に進むことが必要と思われる．

　This paper deals with the incidence and clinical treatment of GIST (gastrointestinal stromal tumors) at this unit. GIMT (gastrointestinal mesenchymal tumors) are discovered in about 0.3% of persons who undergo X-ray examinations of the stomach in medical health checks. At present, the term GIST is used in pathological diagnosis and the clinical diagnosis is made as GIMT. Among GIMT patients, the incidence of GIST, myogenic tumors, and neurogenic tumors was 70.7, 24.4% and 4.9%, respectively. Using conventional diagnostic criteria for pathological malignancy of myogenic tumors, GIST was diagnosed as benign and malignant in 52.4% and 90% of cases, respectively. The size of GIMT was not correlated with the incidence of GIST. Clinically, the conventional diagnostic criteria for malignancy of myogenic tumors can also be applied to GIST. Now that genetic research is at an advanced stage, however, it will be necessary to take histological specimens to make accurate histological diagnosis before determining clinical treatment.