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患者女性,69岁。因上腹隐痛、出现黑便2个多月,于1994年8月29日入院。无恶心呕吐、腹胀,胃纳一般,小便正常,内镜检查提示胃体前壁有2cm赘生物伴出血,拟为胃肿瘤伴出血。患者10余年前行左大腿汗腺癌切除术,4年前行头皮汗腺癌切除术。入院时检查:老年贫血貌,上腹部剑突下轻度压痛,腹软,无肿块触及。头顶正中有2cm×2cm肿块。实验室检查:肝肾功能正常,粪便隐血试验(++),血红蛋白54g/L,白细胞3.1×l0~9/L。临床诊断;胃肿瘤伴出血,头皮汗腺癌复发。剖腹探查见胃体上部大弯侧前壁有3cm×2cm大小肿块突向胃腔,区域淋巴结未见明显肿大,肝脏、盆腔未及转移灶,行胃部分切除术,切缘距肿瘤边缘约4cm。切除标本剖开发现肿块呈柱状突向胃腔,表面有坏死出血灶。病理诊断:胃体前壁转移性低分化汗腺癌。1周后在局麻下行头顶部肿瘤切除术,颅骨外板完整。病理诊断:头皮低分化汗腺癌。术后恢复良好,15
Female patient, 69 years old. He was admitted to the hospital on August 29, 1994 for more than two months due to abdominal pain and dark stools. No nausea and vomiting, abdominal distension, general appetite, normal urine, endoscopy prompted the front wall of the body has 2cm of vegetation with hemorrhage, intended for gastric cancer with bleeding. The patient had undergone a resection of sweat gland adenocarcinoma of the left thigh more than 10 years ago and a scalp sweat gland cancer resection four years ago. At the time of admission, examination was performed on the appearance of senile anaemia, mild tenderness under the xiphoid abdomen, soft abdomen, and no lumps touched. There is a 2cm x 2cm mass in the middle of the head. Laboratory tests: normal liver and kidney function, fecal occult blood test (++), hemoglobin 54 g/L, WBC 3.1×10-9/L. Clinical diagnosis; Stomach cancer with bleeding, scalp sweat gland cancer recurrence. For exploratory laparotomy, the large anterior wall of the upper body of the corpus callosum, with a size of 3cm x 2cm, protrudes into the stomach cavity. There is no significant enlargement of regional lymph nodes. There is no metastases in the liver and pelvis. A partial gastrectomy is performed. The margin is approximately from the edge of the tumor. 4cm. Excision specimens were cut open and found that the mass was columnar to the stomach cavity with necrotic hemorrhage on the surface. Pathological diagnosis: metastatic low differentiation of the anterior gastric body sweat gland cancer. After 1 week, the head of the skull was removed under local anesthesia and the outer skull plate was intact. Pathological diagnosis: scalp low differentiation sweat gland cancer. Good postoperative recovery, 15