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患者男,54岁。无诱因间歇性上腹疼痛8个月,明显消瘦3个月,体重下降8 kg,于2005年4月14日收入院。纤维电子胃镜检查:胃底有一个4 cm×3 cm大小的不规则形溃疡,被覆污苔,质脆,易出血,取活检3块。病理检查:癌组织散在分布在肌纤维间,部分区域呈小腺管样结构(图1)。免疫组织化学:癌细胞CK(AE1／AK3,图2)、癌胚抗原、上皮细胞膜抗原均阳性。病理诊断:胃底低分化腺癌。确诊第16天,行胃近端癌根治术,取左胸腹联合切口,术中发现左胸后壁第8、9肋间壁层胸膜距降主动脉1 cm处,见一3 cm×3 cm大小的肿块,无包膜,实性,质软,棕黄色。临床考虑胃癌转移,送病理检查。
Male patient, 54 years old. No incentive to intermittent upper abdominal pain for 8 months, significantly wasting 3 months, weight loss 8 kg, on April 14, 2005 income hospital. Fiber electronic gastroscopy: gastric fundus has a 4 cm × 3 cm irregular shaped ulcers, covered with foul moss, crisp, easy to bleed, take 3 biopsy. Pathological examination: Cancer tissue scattered in muscle fibers, some areas showed a small duct-like structure (Figure 1). Immunohistochemistry: Cancer cells CK (AE1 / AK3, Figure 2), carcinoembryonic antigen, epithelial membrane antigen were positive. Pathological diagnosis: gastric poorly differentiated adenocarcinoma. Diagnosis of the first 16 days, the line of proximal gastric cancer radical surgery, left thoracoabdominal incision, surgery was found in the left chest wall 8,9,9 intercostal parietal pleura aortic 1cm distance, see a 3 cm × 3 cm Size of the tumor, no capsule, solid, soft, brown. Clinical consideration of gastric cancer metastasis, sent pathological examination.