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患者男,69岁。咳嗽、咳痰,呼吸困难3月余,加重1个月,同时感有上腹部不适,有时隐痛,食欲欠佳。x线检查发现右肺下叶球形病灶,直径约2.5cm,痰结核菌PCR检查阳性。曾患慢性支气管炎10余年。胃镜检查发现贲门小弯侧有一直径约2cm隆起的肿块,其表面胃粘膜完好。临床诊断:(1)胃平滑肌瘤;(2)慢性支气管炎伴肺结核。于97年7月18日行胃肿瘤切除术,剖开胃壁,见胃壁肿块突入胃腔内,切开胃粘膜层,见肿瘤位于粘膜下层,境界尚清,将肿瘤及部分胃壁切除。病理检查:部分胃壁切除标本,4cm×4cm×3cm大小,切面见粘膜下层有一不规则形肿瘤,约1.8cm×1.5cm×1.2cm大小,呈淡黄色,实质性,部分有包膜,未累及肌层。镜检发现肿瘤由脂肪组织和小量纤维血管构成,脂肪细胞分化成熟,呈小叶状结构,胞浆丰富且空淡,胞核小而圆形,多位于中央,无核分裂相。免疫组化检查:S-100(+),Vimentin
Male patient, 69 years old. Cough, sputum, dyspnea more than 3 months, an increase of 1 month, while feeling upper abdominal discomfort, sometimes pain, poor appetite. X-ray examination revealed that the right lower lobe spheroid lesions were about 2.5 cm in diameter, and the tuberculosis sputum PCR was positive. He suffered from chronic bronchitis for more than 10 years. Gastroscopy revealed a small lumps with a diameter of about 2 cm on the minor curve of the cardia, and its surface gastric mucosa was intact. Clinical diagnosis: (1) gastric leiomyoma; (2) chronic bronchitis with pulmonary tuberculosis. On July 18, 1997, he underwent gastric cancer resection and cut off the appetite wall. The gastric wall mass protruded into the stomach cavity and cut the appetite mucosa. The tumor was located in the submucosa and the state was still clear. The tumor and part of the stomach wall were removed. Pathological examination: Part of the gastric wall resection specimens, 4cm × 4cm × 3cm in size, the cut surface see the submucosa with an irregular tumor, about 1.8cm × 1.5cm × 1.2cm size, pale yellow, substantial, part of the envelope, not involving Muscle layer. Microscopic examination revealed that the tumor consisted of adipose tissue and a small number of fibrous blood vessels. The adipocytes differentiated and matured, showing a leaflet-like structure with abundant cytoplasm and a faint nucleus. The nucleus was small and round, mostly located in the center, and had no nuclear fission stage. Immunohistochemistry: S-100(+), Vimentin