The principle of treatment for gastrointestinal mesenchymal tumors is that surgery is the first choice, and after surgery, according to the risk level of the tumor, we will determine whether we need to take Gleevec targeted drugs to prevent recurrence. If the risk of surgery is very high and traumatic, you can also take Gleevec orally first, and then operate after the tumor shrinks. The so-called “quasi” gastrointestinal mesenchymal tumor means that the clinician, based on clinical experience, makes a preliminary diagnosis of some tumors in the abdominal cavity as “gastrointestinal mesenchymal tumor”, which can be understood as “clinical diagnosis”. Of course, clinical diagnosis cannot replace pathology. Of course, clinical diagnosis cannot replace pathological diagnosis, but the final diagnosis is pathological diagnosis. The final diagnosis is the pathological diagnosis. Clinical treatment also needs to be based on the pathological diagnosis before the right medicine can be prescribed. Wang Gangcheng, Department of General Surgery, Henan Cancer Hospital Why do you say it is “quasi” gastrointestinal mesenchymal tumor? Before there is pathological diagnosis, physicians judge the tumor as gastrointestinal mesenchymal tumor according to its location, shape, size, boundary and structure. In fact, the error rate between clinical diagnosis and final pathological diagnosis of gastrointestinal mesenchymal tumor is relatively small and usually very close. It is not that physicians are eagle-eyed, but because most gastrointestinal mesenchymal tumors are relatively easy to determine. Although the clinical diagnosis of gastrointestinal mesenchymal tumor is basically determined, without the pathological diagnosis, it is still not possible to use the medication for the disease. Therefore, it is imperative to clarify the pathological diagnosis before medication, which is fully in line with medical procedures. The pathological diagnosis before treatment can only be made by two means: puncture or surgical biopsy. In order to reduce the pain and economic burden of patients, most physicians choose to take biopsies by puncture. Today, we will focus on biopsy before treatment of gastrointestinal mesenchymal tumor. A very important principle of tumor treatment is to ensure the integrity of the tumor. If the tumor breaks down, it will easily lead to tumor dissemination and metastasis. This is especially true for gastrointestinal mesenchymal tumor. Experts at home and abroad agree that if a gastrointestinal mesenchymal tumor ruptures is equal to stage IV tumor dissemination, so how to ensure that the tumor does not rupture is the key to gastrointestinal mesenchymal tumor treatment. Gastrointestinal mesenchymal tumors are mostly cystic solid structures with intact envelope from imaging. In fact, according to what is seen in surgery, gastrointestinal mesenchymal tumors can be broadly categorized into three types morphologically: 1. Tumors with more solid structures, thicker envelope, smoother tumors and fewer peri-envelope vessels. This type of tumor is relatively hard and not easy to rupture. 2. The tumor has cystic solid structure, thin envelope, and angry vascularity on the surface of the envelope. Most of the gastrointestinal mesenchymal tumors seen in clinic belong to this type of tumors, which can easily rupture and bleed, resulting in the dissemination of the cystic contents. 3. Tumors without solid structure and with pseudo-envelope. This type of tumor is very soft and almost difficult to get in hand, and it will break when touched, and this type is also relatively rare. Therefore, most of the gastrointestinal mesenchymal tumors are fragile and bleed easily. During intraoperative exploration, we repeatedly encounter patients with preoperative puncture who have accumulation of blood in the abdominopelvic cavity mostly exist. Where does the blood accumulation originate? Obviously, it comes from the tumor, which is equivalent to tumor rupture and dissemination. Again, it is necessary to have pathological diagnosis before taking medication for gastrointestinal mesenchymal tumor, which means that puncture or biopsy is needed, in full compliance with the treatment procedure. Puncture is easy to bleed and spread metastasis, but still must be punctured, whether to puncture or not? According to the American Center for Cancer Treatment and the consensus of domestic experts, it is believed that puncture of gastrointestinal mesenchymal tumor requires a biopsy or puncture only when a physician with extensive experience is available. This statement itself has different interpretations. Who among the physicians who puncture to take biopsies admits that they are not experienced? In my opinion, if the clinical diagnosis is “quasi” gastrointestinal mesenchymal tumor, the physician should not easily puncture the tumor, but first consult with the surgeon to see if the tumor can be completely removed. For surgeons, if the clinical diagnosis is “quasi” gastrointestinal mesenchymal tumor and the imaging judgment is that they cannot remove the tumor completely, they should not easily open and take a biopsy, but can refer to a higher level hospital or invite a highly skilled surgeon to help with the surgery. For those patients who are judged to be inoperable, they should ask a physician with rich experience in the field to perform the puncture. After all, once the tumor is incomplete, it is difficult to achieve satisfactory results even if the surgery is repeated. Besides, for cystic solid or blood-rich gastrointestinal mesenchymal tumors, the puncture may easily fail to penetrate the substantial tissues, and the desired pathological results will not be obtained.