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晚期十二指肠癌引起左锁骨上淋巴结转移常见,但仅发生左腋下淋巴结转移而原发病灶隐匿罕见,现报道1例如下.临床资料患者,男性,59岁.因左腋下无痛性、进行性增大肿块半年,于1997年3月12日来院门诊.起病后,无其他各系统症状.查体:左腋下可触及一约3cm×4.5cm质坚肿块,表面凹凸不平,边界尚清,基底粘连,欠活动,无压痛.颈部、锁骨上、右腋下及腹股沟等处无肿大淋巴结,胸腹壁、左上肢亦未触及肿块,左腋下肿块切除作病理检查,诊断为“左腋下”淋巴结转移性或浸润性低分化鳞癌.经肺部及纵隔CT等检查,仍未发现阳性征象.病理切片诊断为“左腋下”淋巴结转移性低分化腺癌.再行电子胃镜检查才发现十二指肠隆部前壁见一大小约1.5cm×2.0cm粘膜隆起样新生物,表面粘膜糜烂、乳头窥视不清,胃窦前壁大小弯侧各见一约0.5cm×0.4cm的圆盘状粘膜隆起,有脐凹,诊断为十二指肠降部癌.
Late duodenal cancer causes common left supraclavicular lymph node metastasis, but only the left axillary lymph node metastasis occurs and the primary lesion hides rare. It is reported as follows. Clinical data, male, 59 years old. No pain due to left lower jaw Sex, progressive enlargement of the mass for half a year, came to the outpatient clinic on March 12, 1997. After onset, there were no other systemic symptoms. Physical Examination: A mass of about 3cm x 4.5cm masses was touched on the left side of the jaw, uneven surface , The border is still clear, basal adhesions, lack of activity, no tenderness. There are no enlarged lymph nodes in the neck, supraclavicular, right infraorbital, and groin, and there is no mass in the thoracoabdominal and left upper limbs. The left subphrenic mass is removed for pathological examination. ,Diagnosis of “left infraorbital” lymph node metastatic or infiltrating poorly differentiated squamous cell carcinoma. By lung and mediastinal CT examination, no positive signs have been found. Pathological section diagnosed as “left infraorbital” lymph node metastatic poorly differentiated adenocarcinoma Electronic gastroscopy again found that the anterior wall of the duodenal protuberances found a new biological specimen about 1.5cm x 2.0cm in size. The mucosal erosion on the surface and the peeping of the nipples were unclear. About 0.5cm x 0.4cm disc-shaped mucosal uplift, umbilical hernia, diagnosed as ten Descending duodenum cancer.