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患者女,53岁,因上腹胀痛1月余,间断黑便20天入院.既往健康.查体:贫血貌,锁骨上淋巴结无肿大,腹软,上腹充实感、压痛,肝、脾未及,腹水征(一).B超示:“胆囊炎,胆囊息肉”,胃肠钡餐检查示“胃窦炎”.CT示胃壁粘膜增厚,肝脾不大.胃镜下见胃体后壁、胃体小弯广泛粘膜增厚水肿,斑片状糜烂出血,镜下充气后扩张不好,取检时组织硬、脆;常规病理报告为慢性浅表性胃炎,未见肿瘤细胞,遂行第二次胃镜下活检,仍未查到肿瘤细胞.两次胃镜下印象分别为胃癌和胃淋巴瘤,但病理上均未获证实.经内科积极治疗,上消化道出血仍不止.患者曾连续3次出现输血反应(畏寒,高热),第三次输血出现酱油色尿,Hb由入院时的60g/L,一周后下降到50g/L.查ABO血型,亚型及Rh血型未见异常,有关溶血检查无异常,骨髓示缺铁性贫血.改输洗涤红细胞,Hb上升至75g/L后,行剖腹探查术.术中见:胃大弯及后壁一约10cm×10cm大小肿块,向胃底及大弯浆膜外浸润,网膜、盆腔广泛转移,中度腹水.病理报告:胃低分化腺癌,伴部分未分化癌.大网膜脂肪纤维组织中见低分化腺癌(部分为未分化癌).
Female, 53 years old, due to abdominal pain more than 1 month, intermittent black stool 20 days admitted to hospital .Pre-examination: anemia appearance, supraclavicular lymph node enlargement, abdominal soft, upper abdominal sensation, tenderness, liver, Spleen and ascites (a). B ultrasound showed: “cholecystitis, gallbladder polyps,” gastrointestinal barium meal showed “antral gastritis.” CT showed gastric mucosal thickening, liver and spleen is not. Posterior wall, gastric mucosal lesser curvature thick mucosal edema, patchy erosive bleeding, inflatable microscopic expansion is not good, take the test tissue hard and brittle; routine pathological reports of chronic superficial gastritis, no tumor cells, Underwent the second endoscopic biopsy, tumor cells have not yet been found.Two under endoscopy were gastric cancer and gastric lymphoma, but the pathology have not been confirmed by the active medical treatment, upper gastrointestinal bleeding is still more than patients had Blood transfusion reaction (chills, fever) occurred three times in a row, soy sauce color urine appeared in the third blood transfusion, Hb decreased from 60g / L at admission to 50g / L after one week, no ABO blood group, subtype and Rh blood group were found Abnormalities, no abnormal hemolytic examination, bone marrow showed iron deficiency anemia.Transmission red blood cells were transfused, Hb rose to 75g / L, laparotomy .Operation see: Stomach curvature and after An about 10cm × 10cm size of the tumor, infiltration of the gastric fundus and big curved serosa, omentum, pelvic metastasis, moderate ascites.Pathological report: gastric poorly differentiated adenocarcinoma, with some undifferentiated carcinoma omentum fat fiber Poorly differentiated adenocarcinoma of the tissue (part of undifferentiated carcinoma).