2019年 · 第34卷第04期

Against the background of the declining morbidity and mortality of gastric cancer, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing year by year worldwide, and it has become a hot spot in the field of digestive tumors in recent years. With the deepening, intersection and integration of different professional directions, the related concepts of AEG are constantly changing and renewing. This paper aims to analyze the related basic concepts of AEG from the perspective of oncology surgery.

sarcomatoid carcinoma (SC) is a malignant tumor with epithelial and mesenchymal tissue components. It can occur in various organs of the whole body, but it is more common in the respiratory tract, lung, breast and kidney^[1], pancreas is extremely rare. sarcomatoid carcinoma of pancreas (SCP) is a malignant epithelial tumor originating from the pancreas, which has the characteristics of high malignancy, rapid development, early metastasis and poor prognosis. Our hospital has treated 2 patients in recent years, which are reported as follows in combination with relevant literature analysis.

An 81-year-old male was admitted to the hospital for "intermittent abdominal distension and pain for half a month". Physical examination: abdominal swelling, no gastrointestinal pattern and peristaltic wave, soft abdomen, tenderness in the left middle and lower abdomen, no muscle tension and rebound pain, no mass palpable in the abdomen, drum sound during percussion, and hyperactive intestinal sound. Laboratory tests: Serum carbohydrate antigen 19-9 98.1 U/ml. Total abdominal CT scan showed that the local wall of the small intestine in the abdominal cavity was thickened, the intestinal lumen was narrowed, and its proximal intestinal obstruction (Figure 1)。 The clinical diagnosis was intestinal obstruction, and the abdominal pain and distension could not be relieved after 3 days of non-surgical treatment, so exploratory laparotomy was performed. During the operation, it was found that there was a tumor about 5 cm long in the small intestine at 100 cm of the ileocecal region, which showed annular cavity growth, and the small intestine was completely obstructed. Multiple enlarged lymph nodes were seen near the mesenteric lining of the small intestine (Figure 2)。 Enterectomy and intestinal anastomosis were performed, and 10 cm each of the distal and proximal ends of the tumor and the mesenteric membrane to which they belonged were removed. Postoperative pathological report: differentiated squamous cell carcinoma of small intestine (Figure 3), peritoneal penetration, upper and lower stumps (-), vascular tumor thrombus (+), peri-intestinal lymph node metastatic carcinoma (3/4). Immunohistochemical staining results: CK7 (−), CK20 (−), Ki-67 (~20% +), P40 (+), P63 (+), EMA (+), TTF-1 (−), CD56 (−), Syn (−), LCA (−), S100 (−), HMB45 (−), Vimentin (−), CD34 (vascular +), D2-40 (lymphatic +), Villin (−). The patient recovered well after surgery and was followed up for 1 year without discomfort.

A 36-year-old female was admitted with epigastric pain for 10 h. The patient had severe pain under the xiphoid process of the upper abdomen with no obvious trigger, accompanied by pain in the lower back. CT examination in the local hospital considered the possibility of pancreatitis and was admitted to the emergency department. Physical examination: heart rate 96 beats/min, blood pressure 90/56 mmHg, left upper abdomen and subxiphoid tenderness positive, rebound pain suspected positive. WBC 9.8×10⁹/L, Hb 10.7g/L, blood amylase normal; Upper abdominal enhanced CT (Figure 1) showed a 9 cm cystic-solid space-occupying lesion in the tail of the pancreas and retroperitoneal hemorrhage, and the diagnosis considered solid pseudopapillary tumor of the pancreas with left retroperitoneal hemorrhage. Emergency surgery showed cystic-solid space-occupying lesions in the body and tail of the pancreas. The rupture of the tumor was located in the posterior wall of the tumor, and a large amount of blood accumulated in the left retroperitoneum, which was closely related to the blood vessels of the spleen. The body and tail of the pancreas were combined with splenectomy and the local enlarged lymph nodes were dissected. The abdominal cavity was washed with 3000 ml of sterile injection water, and the postoperative recovery was smooth. Postoperative pathology: Solid pseudopapillary tumor of the pancreas.