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病历摘要男患,67岁,病案号121904。入院前3个月于背部右侧发现逐日增大的杏仁大肿物,无红肿。既往无溃疡病史。体检在胸壁右腋后线8～10肋间处可触及5×4cm 肿物,与皮肤粘连,界清,质中等,表面不甚光滑,无波动感.诊为胸壁神经纤维瘤,在局麻下距肿物边缘2cm 梭形切除肿物.病理报告:皮下转移粘液腺癌。为寻找隐匿的原发灶,行消化道钡透:胃小弯侧有钡斑,周围粘膜中断,报告为胃小弯溃疡,不能除外癌变。胃镜检查:胃小弯侧限局隆起,粘膜表面凹凸不平,部分有坏死物覆盖,病理诊断:胃粘液腺癌。讨论胃癌以淋巴转移为重要途经.血行转移多见于胃癌晚期,杨光霖等报道胃癌360例尸检中,脏器转移以肝(137例38.1%)、肺(116例32.2%)最多,皮肤转移(3例0.8%)少见.皮肤转移可以
The medical record summary was male, 67 years old, case number 121904. On the right side of the back three months before admission, a large mass of enlarged almonds was found daily, with no redness. No past history of ulcers. The physical examination can reach 5×4cm masses at the intercostal space between the right and left sides of the chest wall at the right and left sides of the chest wall. It is infiltrated with the skin and has clear borders. It is of moderate quality, and the surface is not very smooth. There is no fluctuating feeling. The diagnosis is chest wall neurofibroma in the local anesthesia. 2cm from the edge of the mass removed from the mass of the spindle. Pathology report: Subcutaneous mucinous adenocarcinoma. In order to find the hidden primary lesions, the digestive tract was spasm through: the minor curvature of the stomach had ecchymosis and the surrounding mucosa was interrupted. It was reported as a minor gastric ulcer, and cancerous lesions could not be ruled out. Gastroscopy: the gastric curvature of the minor side of the Council uplift, uneven mucosal surface, some covered with necrosis, pathological diagnosis: gastric mucinous adenocarcinoma. Discussion of lymphatic metastasis as an important pathology of gastric cancer. Hematogenous metastasis is more common in the late stage of gastric cancer. Yang Guanglin et al. reported that in 360 autopsies of gastric cancer, liver metastases (38.1% in 137 cases), lung (116% in 32.2%) were the most common, and skin metastases (3 Example 0.8%) rare. Skin transfer can be