确诊GIST,胃里有1个4.1cm肿块 确诊GIST,寻找病因,以及治疗方案和费用 - 图文问诊

病例信息
疾病描述: 确诊GIST没有明显不适,大便不成型,偶尔胃痛。做了胃镜和CT发现4.1cm肿块触碰会出血,以及几个小结节不确定是什么,已预约MRI和病理检测。(2022-01-13填写)
身高体重: 180cm,95.6kg(2022-01-12测量)
疾病: 确诊GIST,胃里有1个4.1cm肿块(2022-01-13填写)
希望得到的帮助: 是需要先手术再药物治疗,还是先药物(格列卫)再观察情况手术。以及病因:家庭有乙肝转癌,但本人没有乙肝
患病时长: 半年内
用药情况: 泮托拉唑钠40mg,一天两次,分别在早晚饭之前半个小时,每次一片
过敏史: 青霉素(2022-01-13填写)

问诊建议 2022-01-17 徐岩医生给出

诊疗建议由医生根据当前病情给出,仅适用于本次问诊
病历概要

胃部间质瘤,约4cm。咨询下一步治疗方案

处置建议

首选手术治疗,切除肿瘤,做基因检测,根据检测结果,选择药物。

徐岩医生团队与患者的交流

问诊中医生回复仅供参考,正式建议及处置方案需见诊疗建议
2022.01.13
徐岩 主任医师

徐岩 主任医师

你好

2022.01.13
徐岩 主任医师

徐岩 主任医师

能否把胃镜报告和ct报告发给我

2022.01.13
患者

患者

CT CHEST/ABDOMEN/PELVIS W C + 3D - Details Study Result Narrative INDICATION: Proximal gastric mass for staging. COMPARISON: None available. TECHNIQUE: Axial CT images of the thorax, abdomen, and pelvis was performed with multiplanar reformats. IV contrast was administered. FINDINGS: CT thorax: The central tracheobronchial tree is patent. No pleural effusions. No focal groundglass or dense airspace opacities. 0.3 cm groundglass opacity within the left lower lobe, image 81, series 204. 0.2 cm subpleural nodule within the right lower lobe, image 65. Right lower lobe subpleural nodule measuring 0.3 cm, image 90. 0.6 cm perifissural/subpleural right upper lobe nodule, image 62. No significant axillary, supraclavicular, mediastinal, or hilar lymphadenopathy. Residual thymic tissue. No central pulmonary emboli. No pericardial effusions. No mid or distal paraesophageal lymphadenopathy. No acute fractures or destructive bone lesions involving the thoracic cage. CT abdomen and pelvis: There is a soft tissue density mass centered within the posterior aspect of the gastric fundus/cardia measuring approximately 3.8 x 4.1 x 4.1 cm, best seen on image 114, series 201 and image 76, series 202. I suspect the mass is predominantly submucosal extending to the serosal margin. However, there is mucosal irregularity as seen on image 71, series 202. No discrete extension beyond the serosal margin. Suspicious locoregional gastrohepatic lymph node measuring up to 1.0 cm in short axis diameter, image 114, series 201. The gastroesophageal junction appears spared, best appreciated on image 68, series 202. The more distal aspect of the stomach is unremarkable. No small bowel obstruction. Colon is unremarkable. Normal appendix. No ascites. No peritoneal nodularity or omental thickening. Hypoattenuation along the falciform ligament, some of which is likely related to focal fat deposition. However there is a more rounded hypoenhancing focus within segment IVb measuring 1.5 x 1.5 cm, best seen on

2022.01.13
患者

患者

best seen on image 124, series 201 and image 41, series 202. No other focal liver lesions identified. The spleen, adrenals, pancreas, gallbladder, and biliary tree are unremarkable. No focal renal lesions. No hydronephrosis. No perinephric stranding. No ureteric calculi. Bladder is thin walled. Prostate is normal size. No retroperitoneal lymphadenopathy. Portal vein is patent. No AAA. No acute fractures or destructive bone lesions involving the lumbosacral spine. OPINION: 1. 4.1 cm proximal gastric fundal/cardia mass within associated enlarged gastrohepatic lymph node. This is highly concerning for an underlying gastric malignancy such as adenocarcinoma or possible GIST. Indeterminate lesion adjacent to the falciform ligament of the liver, which may represent a more rounded area of focal fat deposition, however underlying mass cannot be excluded and further assessment with MRI is recommended. 2. Bilateral nonspecific subcentimeter lung nodules. Short-term follow-up CT thorax examination is recommended in 3 months to reassess. Component Results There is no component information for this result.

2022.01.13
患者

患者

抱歉也是帮忙问,上面是CT报告

2022.01.13
患者

患者

Component Results Component ADDENDUM Your Value Part C: As per guideline for counting mitotic figures in gastrointestinal stromal tumors, a total count of mitosis per 5 mm2 is required. This will ideally be done on the resection specimen. The current biopsy is composed of multiple fragments and therefore it is challenging to count the mitotic figures in a 5 mm2 area; however, as per request of responsible clinician the mitotic figures were counted in a mitotically active area. There are 13 mitotic figures within an area of approximately 1 mm2. This was reviewed with a second pathologist. A. Antrum, Biopsy: -Antral type mucosa within normal limits -Special stain for Helicobacter pylori organisms is negative B. Stomach Body, Biopsy: -Body type mucosa within normal limits -Special stain for Helicobacter pylori organisms is negative C. Fundal Mass, Biopsy: -Gastrointestinal stromal tumor (GIST) -See comment Standard Flag Range FINAL DIAGNOSIS COMMENT Sections in part C show numerous fragments of gastric mucosa with a submucosal proliferation of a mixture of epithelioid and spindle cells. These cells demonstrate high N/C ratio and hyperchromatic nuclei. Mitotic figures are readily apparent. Upon immunohistochemistry, the cells of interest are diffusely and strongly positive for DOG1, CD117, and, CD34. They are negative for AE1/AE3, CK7, CK20, SMA, S100, and, CD45. Special stain for Helicobacter pylori organisms is negative. Overall findings are those of a gastrointestinal stromal tumor (GIST) which is present at the biopsy edges. This case was reviewed within the department with consensus. Pre-op Diagnosis: Abdominal symptoms Post-op Diagnosis: R19.8 - Abdominal symptoms Specimens: A) - Antrum, Biopsy B) - Stomach Body, Biopsy C) - Fundal Polyp, fundul mass CLINICAL INFORMATIO N CASE REPORT GROSS DESCRIPTIO N A) Antrum, Biopsy: The specimen container is labeled antrum, biopsy. Received in formalin are 2 fragments of tan soft ti

2022.01.13
患者

患者

A) Antrum, Biopsy: The specimen container is labeled antrum, biopsy. Received in formalin are 2 fragments of tan soft tissue ranging in size from 0.2-0.3 cm in maximum dimension. The specimen is entirely submitted for microscopy in block A1. B) Stomach Body, Biopsy: The specimen container is labeled stomach body, biopsy. Received in formalin are 2 fragments of tan soft tissue ranging in size from 0.2-0.4 cm in maximum dimension. The specimen is entirely submitted for microscopy in block B1. C) Fundal Polyp: fundul mass The specimen container is labeled fundal polyp (fundul mass). Received in formalin are multiple fragments of tan soft tissue ranging in size from 0.1-0.4 cm in maximum dimension. The specimen is entirely submitted for microscopy in block C1.

2022.01.13
患者

患者

您如果还需要别的资料我再去问

2022.01.13
患者

患者

非常感谢🙏您辛苦了

2022.01.13
徐岩 主任医师

徐岩 主任医师

有照片吗?

2022.01.13
徐岩 主任医师

徐岩 主任医师

直接把报告拍照发给我就行

2022.01.13
患者

患者 图片资料,仅主诊医生和患者本人可见

2022.01.13
患者

患者 图片资料,仅主诊医生和患者本人可见

2022.01.13
患者

患者 图片资料,仅主诊医生和患者本人可见

2022.01.13
患者

患者 图片资料,仅主诊医生和患者本人可见

2022.01.13
患者

患者 图片资料,仅主诊医生和患者本人可见

2022.01.13
患者

患者

上面是CT的照片

2022.01.13
患者

患者 图片资料,仅主诊医生和患者本人可见

没有更多交流了~
徐岩医生与此患者的全部就诊记录 >
徐岩医生的相关内容
胃底黏膜下隆起病变间质瘤2慢性非萎性胃炎_肚脐周边疼痛一月 做胃肠镜检查 发现胃底黏膜下隆起间质瘤 慢..._是否需要手术 目前建议如何处理及处理方式 是恶性肿瘤么 如果手术复发概率如何 需要注意什么- 好大夫在线专家团队
医生最新回复:查看详情
胃间质瘤术后病理_胃间质瘤判断
医生最新回复:按照标准,核分裂像大于10就算高危
胃介质瘤和高血压_胃介质瘤和高血压_因为术中破裂,是否低危变高危,转移或复发概率很高,我们应该怎么治疗? - 好大夫在线图文问诊
医生最新回复:问诊小结 病历摘要:中年男性,胃间质瘤,胃镜下切除术中破裂,急诊手术修补。 处置建议:从判断标准来说,肿瘤破裂是复发的高危因素,但并不代表一定会复发。但需要口服伊马替尼,至少三年。定期复查。如果条件允许,建议做基因检测,进一步判断是否对药物敏感。
腹腔镜手术、微创手术、开腹手术有什么区别_腹腔镜手术_手术_治疗介绍 - 好大夫在线
5371人已读
怀疑胃癌,胃疼,胃胀,吃药后还疼_病历切片报告单上写印戒样改变,请问是胃癌吗?_报告单子上写有胃炎,印戒样改变,请问是胃癌吗? - 好大夫在线图文义诊
医生最新回复:我仔细看了你所有的材料,从胃镜和病理结果来看病变主要在胃窦,而且病理结果上提示见到印戒样细胞,确实有癌变的可能。我建议把当地的病理切片借出来,拿到大医院的病理科复查会诊,进一步明确是否癌变。如果会诊未见到癌细胞,我建议内科治疗1个月后,到大医院复查胃镜,重新取组织做病理检查。也可以直接复查胃镜,重新取组织做病理。
糖尿病多年_糖尿病多年_请问如何手术?我有糖尿病,对手术有影响吗? - 好大夫在线图文问诊
医生最新回复:问诊小结 病历摘要:胃镜发现0.5cm的粘膜下肿物,间质瘤可能大。是否需要手术 处置建议:小于2cm的胃间质瘤,可以暂时观察,不一定需要立刻手术。建议每半年复查超声胃镜,如果肿物明显增大,则考虑手术切除。
17年6月胃间质瘤手术 4.4中风险,胃间质瘤术后4年。,在原手术位置附近长1.6结节 不知道是什_胃间质瘤可能二次复发_这次长得这个6是复发吗 怎么办 - 好大夫在线图文问诊
医生最新回复:没关系
胃间质瘤_胃间质瘤严重吗
医生最新回复:[语音 33s]
胃癌_20岁怎么会得胃癌
医生最新回复:病情摘要/结论: 病情摘要及初步印象: 年轻女患,贫血,胃镜见胃体粘膜散在隆起,病理结果待回报。; 总结建议:待病理结果回报,决定下一步治疗方案。暂时口服保护胃粘膜药物,纠正贫血。 病理结果出来后,让我再看看。
胃胀,吐酸水,打隔_请徐教授,帮我看一下基因检测的结果_已做完手术 - 好大夫在线图文问诊
医生最新回复:病情摘要/结论: 病情摘要及初步印象: 老年男性,胃癌术后,T4N3M0,咨询目的:咨询HER2检测结果 总结建议: 从提供的报告看,为阳性,根据家里经济条件和身体情况,如果允许,可以加用靶向药赫赛汀。
查看更多相关内容
更多相关内容

袖状胃切除手术是什么?要符合什么条件才能做这个手术? - 好大夫在线
戴晓江 · 佑道医生集团 · 减重及糖尿病外科
阿帕替尼三线治疗转移性胃癌有效 - 好大夫在线
曾辉 · 武汉市第六医院 · 肿瘤科
肠内营养在胃肿瘤全胃切除术后的疗效观察 - 好大夫在线
秦伟 · 抚顺市中心医院 · 普通外科
胃疼_张主任,这是第三次问诊,第二次您给开的方子昨天已喝完,相比之..._请您给开方子- 好大夫在线专家团队
张润顺 · 中国中医科学院广安门医院 · 脾胃病科
胃癌的分型_胃癌_疾病介绍_介绍 - 好大夫在线
尚志梅 · 潍坊市中医院 · 肿瘤中心
HER-2靶向治疗方案对胃癌有效 - 好大夫在线
刘蒲香 · 山东第一医科大学第三附属医院 · 肿瘤内科
胃老是涨,做了个胃镜_胃胀,一天吃好多顿,夜里都吃,_帮忙看看说是胃癌,想看看严重吗,怎么治疗 - 好大夫在线专家团队
赵刚 · 上海交通大学医学院附属仁济医院(东院) · 胃肠外科
胃镜检查浅表性胃炎,胃胀,不好受吃过饭,胃胀不适3月余_我女儿缘于3月余前进食凉海带之后_希望贺教授好好看看。 - 好大夫在线专家团队
贺德志 · 郑州大学第一附属医院 · 消化内科
淋巴瘤怎么治疗? - 好大夫在线
许景艳 · 南京鼓楼医院 · 血液内科
腹腔镜联合胃镜治疗邻近贲门或幽门的胃间质瘤 - 好大夫在线
崔明 · 北京大学肿瘤医院 · 胃肠肿瘤中心四病区

接诊医生:
擅长:结肠癌、直肠癌、大肠息肉、胃肠道间质瘤(GIST)的微创手术及围手术期综合治疗;中青年早发肿瘤、家族性/遗传性肿瘤的遗传风险评估及综合治疗
收起
患者投票
47
在线问诊量
684
就诊患者:

h*** 男 30岁