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患者男,60岁。3周前无明显诱因进食感下咽困难、胸骨后疼痛,近日渐加重,于1999年5月18日入院。体检:全身浅表巴结不肿大,胸廓对称,无畸形,两肺呼吸音清晰,肝、脾触及。食管镜及X线钡餐透视检查均提示食管中段肿块。临床诊断为食管中段癌。行食管肿瘤切除术。手术所见:食管胸上段主动脉弓后见一处约7cm×4cm×3cm肿块,其活动度差,界限清,外膜与周围组织无粘连,术中诊断为食管平滑肌瘤。 病理检查 食管中段组织,长12cm,上端横径3.5cm,下端横径3cm。距上切缘2.5cm,下切缘2cm处管壁粘膜下见一6.5cm×3.8cm×3cm之息肉状肿物、广基,无明显包膜。其切面为实性、灰白色、鱼肉状、质较软,粘膜表面隆起、发白、尚光滑。光镜检查:瘤组织主要由低分化长梭形细胞构成,呈束状或编织状排列,纵横交错。瘤细胞异型性明显,胞核呈多形性,多为卵圆形、梭形及多边形,核大、深染,染色质粗,核仁明显,可见瘤巨细胞,核分裂象易见,每个高倍视
Male patient, 60 years old. 3 weeks ago no significant incentive to eat swallowing dysphagia, sternal pain after the recent aggravating, in May 18, 1999 admission. Physical examination: systemic superficial stenosis is not enlarged, symmetrical thorax, no deformity, clear breath sounds of both lungs, liver, spleen touch. Esophagoscopy and X-ray barium meal examination revealed mid-esophageal mass. Clinical diagnosis of esophageal cancer. Esophageal resection. Surgical findings: see the upper esophageal aortic arch about a 7cm × 4cm × 3cm mass, the poor mobility, clear boundary, the outer membrane and surrounding tissue without adhesion, intraoperative diagnosis of esophageal leiomyomata. Pathological examination of esophageal tissue, length 12cm, the upper transverse diameter of 3.5cm, the lower transverse diameter of 3cm. 2.5cm away from the cutting edge, the next cut edge 2cm at the wall mucosal see a 6.5cm × 3.8cm × 3cm of the polypoid tumor, wide base, no significant envelope. The section is solid, gray, fish-like, soft quality, mucosal surface bulge, whitish, still smooth. Light microscopy: tumor mainly composed of poorly differentiated spindle cells, arranged in a bundle or braid, criss-cross. Tumor cells atypia obvious, the nucleus was pleomorphic, mostly oval, fusiform and polygons, nuclear large, deep staining, chromatin coarse, obvious nucleoli, visible tumor giant cells, mitotic easy to see, each High magnification