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患者男,68岁。因上腹部间歇性隐痛1月余,数日来解柏油样便于1998年12月6日入院。患者于1973年9月因胃慢性溃疡行胃大部切除,术后一般情况良好。查体:剑突下有压痛,脐上触及一7cm×6cm肿块,可推动,质地较硬。上腹部CT:残胃胃腔内见1个7cm×6cm椭圆形软组织块影,有蒂,密度不均,胃腔变窄:纤维内窥镜检查:残胃胃腔内见1个巨大肿块,表面糜烂,易出血,边缘清楚。诊断:“残胃癌”。1周后在硬膜外麻下行剖腹探查术:见残胃胃壁光滑柔软,吻合口正常,胃腔内巨大肿块附于残胃后壁大弯侧,有蒂,术中经快速病理学检查诊断为粘膜慢性炎症,未见肿瘤组织。将其肿块及其基底部行锲形切除。病理学检查:椭圆形肿块7cm×6cm大小,蒂部3.0cm×0.8cm,表面被覆粘膜,附有较多粘液,部分糜烂。切面见粘膜层有大小不等微小囊,内为粘液或脓样分泌物,间质水肿。镜下见粘膜表面被覆不规则再生的腺体,部分腺体囊状扩张;大部分上皮呈高柱状,胞质较透亮,单层排列,上皮间可见少量杯状细胞;
Male patient, 68 years old. Due to the intermittent pain in the upper abdomen for more than one month, it took several days for the solution of tarry to be admitted to hospital on December 6, 1998. The patient underwent partial gastrectomy due to chronic gastric ulcer in September 1973 and was generally in good condition after surgery. Examination: There is tenderness under the xiphoid and a 7cm x 6cm mass on the umbilicus can be pushed and hardened. Upper abdomen CT: residual gastric stomach cavity see a 7cm × 6cm oval soft tissue block shadow, pedicle, uneven density, narrow stomach cavity: fiber endoscopy: residual stomach stomach cavity see a huge lump, Surface erosion, easy bleeding, clear edges. Diagnosis: “stomach cancer.” After 1 week, laparotomy was performed under epidural anesthesia: the stoma stomach wall was smooth and soft, anastomosis was normal, and a large mass in the stomach cavity was attached to the large curvature side of the posterior wall of the remnant stomach. There was a peduncle and the diagnosis was confirmed by rapid pathological examination during the operation. For mucosal chronic inflammation, no tumor tissue was seen. The lumps and their bases were cut in a zigzag shape. Pathological examination: The oval mass was 7cm×6cm in size, and the pedicle was 3.0cm×0.8cm. The surface was covered with mucous membranes, with more mucus and some erosions. In the cut surface, there are tiny capsular cysts in the mucous layer, mucus or pus-like secretions, and interstitial edema. Under the microscope, the mucosal surface was covered with irregularly regenerated glands, and some glands were cystic. The majority of epithelium showed a tall column with relatively bright cytoplasm and arranged in a single layer. A small amount of goblet cells were seen between epithelium.