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患者男性,58岁.诉心窝部饥饿性疼痛2年余,近3个月来腹痛加剧且不规则,伴乏力、消瘦,时有黑便,体重减轻约5kg.检查:消瘦,贫血貌.血压17.3/10.6kPa,脉率70次/分.浅表淋巴结无明显肿大.两肺听诊正常,心尖区可闻Ⅱ级收缩期杂音.腹软,剑突下轻度压痛,未及肿块.肝脾无肿大.肛门指检无异常.血Hb 58 g/L,肝肾功能正常.血清白蛋白25g/L,球蛋白24g/L.大便潜血(++).胃镜检查:提示胃小弯溃疡型癌.胃窦部多发性腺瘤.胃镜下细胞刷片找到癌细胞.于1987年5月9日行胃窦癌R_2根治术,痊愈出院.随访至今,患者健在,未见肿瘤复发. 胃切除标本肉眼观:胃窦部小弯侧有2×3×1cm溃疡,边缘不规则且硬,已浸润至浆膜面.溃疡远侧胃壁分布有5颗杨梅状肿物,质脆,蒂广,表面附粘液,粘液下方有细绒毛状结构.最大2颗约2×2×1.5cm大小.病理诊断:(1)胃窦部小弯侧低分化腺癌浸润至浆膜;(2)胃窦部多发性绒毛状腺瘤,小区间变I～Ⅱ级. 讨论胃绒毛状腺瘤(又称胃乳头状腺瘤)较为少见,多发生于50岁以上人群组,被认为系一癌前病变,恶变率可高达21～75%.腺瘤往往多发,其边缘胃粘膜常有肠上皮化生、不典型增生等变化,其
The patient was male, 58 years old. He complained of hunger pain for more than two years. In the past 3 months, the abdominal pain was aggravated and irregular, accompanied by fatigue, weight loss, there was black stool, weight loss was about 5kg. Check: weight loss, anemia appearance, blood pressure 17.3/10.6kPa, pulse rate 70 beats/minute. No superficial lymph node enlargement. Auscultation of the two lungs is normal, the apex can be heard of systolic murmur II. Abdominal soft, xiphoid tenderness, no mass. No enlargement of the spleen. No abnormalities in the anal findings. Blood Hb 58 g/L, normal liver and kidney function. Serum albumin 25g/L, globulin 24g/L. Fecal occult blood (++). Gastroscopy: Tip Stomach Benign Ulcerative carcinoma. Gastric sinus multiple adenomas. Endoscopic brushing of cells to find cancer cells. May 5, 1987 Gastric sinus cancer R2 radical surgery, cured and discharged. Follow-up so far, the patient is alive, no recurrence of the tumor. Resection of specimens with naked eyes: There was a 2×3×1cm ulcer on the minor curvature side of the gastric antrum. The edge was irregular and hard and had been infiltrated to the serosal surface. There were 5 poplar-like masses on the distal stomach wall, which was brittle. , Adhesive fluid on the surface, there are fine villous structures underneath the mucus. The largest two are about 2 × 2 × 1.5cm in size. Pathological diagnosis: (1) the poorly differentiated adenocarcinoma of the gastric antrum infiltrate to serosa; (2) stomach Sinus multiple villi Adenoma, inter-cell change I ~ II. Discussion of gastric villous adenoma (also known as papillary adenoma of the stomach) is relatively rare, occurs in more than 50-year-old group, is considered to be a precancerous lesion, malignant transformation rate can be Up to 21 to 75%. Adenomas are often multiple, and their marginal gastric mucosa often has intestinal metaplasia, dysplasia and other changes.