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患者女,53岁。因上腹不适半年,伴疼痛1周于1999年5月5日入院。自述有黑粪史。胃镜检查:胃体小弯粘膜隆起,表面溃烂,范围为5cm×4cm大小。取活检送病理。病理诊断为低分化腺癌,不除外类癌。一周后在全麻下行胃癌根治术。病理检查:大体标本,胃大部切除标本及网膜组织,大弯长17cm,小弯长14cm,沿大弯剖开,见小弯有一突入胃腔的隆起性肿物。范围5cm×4cm,表面糜烂。切面灰白、灰黄。癌侵及浆膜层,质中等。找到网膜淋巴结5枚,最大者1.2cm×0.8cm×0.6cm,最小者0.4cm×0.3cm×0.2cm。镜下,癌肿表面浅溃疡,癌细胞被厚薄不一的纤维分隔呈岛状、小梁状。癌细胞胞浆少且红染,胞界不甚清楚,核大小不等,有明显异型,核圆形、椭圆形、三角形。核仁易见。核分裂像偶见。单个细胞坏死可见。癌细胞排列呈花边状,菊形团状。其中1枚淋巴结内可见癌。免疫组化:神经元特异性烯醇化酶(NSE),嗜铬素A均呈阳性表达。病理
Female patient, 53 years old. Due to abdominal discomfort for six months, with pain for 1 week on May 5, 1999 admitted. Self-report history of black manure. Gastroscopy: Gastrocnemius mucosal uplift, ulceration on the surface, the size of 5cm × 4cm size. Take biopsy to send the pathology. Pathological diagnosis of poorly differentiated adenocarcinoma, not excluding the type of cancer. A week after radical gastrectomy for gastric cancer. Pathological examination: Gross specimen, most of the stomach resection specimens and omentum, large bend 17cm, a small bend 14cm, along the curved curved open, see a small bend into the stomach uplift of the tumor. Range 5cm × 4cm, surface erosion. Section gray, gray. Cancer invasion and serosa, medium quality. Found 5 omentum lymph nodes, the largest 1.2cm × 0.8cm × 0.6cm, the smallest 0.4cm × 0.3cm × 0.2cm. Microscope, shallow ulceration of the surface of cancer, cancer cells were separated by thick and thin fibers were island-like, trabecular. Small cytoplasm of cancer cells and red dye, the cell boundary is not clear, the nuclear size range, there are obvious shaped, nuclear round, oval, triangular. Core easy to see. Fission is occasionally seen. Single cell necrosis visible. Cancer cells arranged in a lace-shaped, daisy-like clumps. One of the lymph nodes visible cancer. Immunohistochemistry: neuron specific enolase (NSE), chromogranin A were positive expression. pathology