2020年 · 第35卷第01期

A 59-year-old female was admitted with "dull pain in the upper abdomen for 1 year, aggravated for 15 days". Physical examination: flat abdomen, tenderness in the upper abdomen, no rebound pain, no palpable mass. Upper abdominal MRI enhancement examination showed that the right side wall of the gastric fundus showed a mass-shaped T1 signal, with a maximum cross-sectional area of about 66 mm ×44 mm and a clear boundary. The enhanced lesions showed obvious delayed enhancement, uneven enhancement, and stripes without enhancement. The right lateral wall of the gastric fundus occupies space, and it is considered that the gastric stromal tumor may be large (Figure 1)。 Gastroscopy showed a huge deep depressed ulcer on the anterior wall of the stomach body, about 5.0 cm ×4.5 cm in size, uneven surface, covered with dirty moss, exposed blood vessels in the center, poor peristalsis, hard texture, and congestion and edema of the surrounding mucosa (Figure 2)。 Laparoscopic assisted partial gastrectomy was performed. During the operation, the gastric mass was located on the anterior wall of the small curve of the gastric body, with a size of about 7 cm ×7 cm ×3 cm, with a smooth surface, intact mucosa, hard texture and poor mobility (Figure 3)。 Complete excision of the mass. Intraoperative pathological examination showed that (gastric tumor) was derived from mesenchymal tissue, and the tumor cells were spindle-shaped and diffusely distributed. There was no involvement of tumor tissue in the resection margin tissue. Postoperative pathological examination showed: (small curved side of gastric body) schwannoma (Figure 4)。 There was no involvement of tumor tissue in the resection margin tissue. Immunohistochemical staining results: CD117 (−), CD34 (vascular +), VIM (+), S-100 (+), SAM (−), Ki-67 (3% +), Desmin (−), CK (−), DOG-1 (−).

A 59-year-old male was admitted with "right upper abdominal pain for 4d". Previous history of "appendectomy" surgery. physical examination : BMI 27.0 kg/m²。 Abdominal distension, mild tenderness in the right upper abdomen, mild muscular tension, and suspected positive Murphy sign. Blood routine: WBC 9.59×10⁹/L, N 0.70, serum CRP 106 mg/L. After admission, the patient's abdominal pain symptoms still gradually worsened and signs of peritonitis appeared. Emergency examination of whole abdominal CT showed: cholecystitis; Abnormal density of fat space below the gallbladder and lateral to the hepatic region of the colon (Figure 1)。 Emergency laparoscopic exploration was performed. About 200 ml of bloody ascites in the abdominal cavity was seen during the operation, and 1/3 of the omentum was torsed from the root by about 360°, and the distal omentum was ischemic and necrotic, with a size of about 8 cm ×10 cm (Figure 2), necrotic omentectomy was performed. Postoperative pathological report: (abdominal mass) vascular congestion and congestion of omentum tissue, accompanied by more inflammatory cell infiltration.

A 60-year-old male was admitted with "metastatic right lower abdominal pain for 24 h". Physical examination: The right lower abdominal muscle is slightly tense, with tenderness to the touch, tenderness at McMaher's point and rebound pain (+). Blood routine: white blood cells 11.15×10⁹/L, N 78%; Blood amylase: 45 U/L; B-ultrasound of the appendix: a tubular hypoechoic structure was detected in the right lower abdomen, the middle and distal segment was thickened, about 1.1 cm in diameter, and the cross-section showed "target ring sign" without peristalsis, surrounded by heterogeneous hyperechoic structures. Laparoscopic exploratory emergency surgery was performed with the diagnosis of "acute appendicitis". A white free ball about 5 cm in diameter was seen at the right abdominopelvic junction during the operation (Figure 1), shiny, without any adhesion to surrounding organs and tissues. The free ball cannot be removed under the microscope. Take the right McCartney incision for conversion to laparotomy. The free ball is removed. The oblique section of the free ball is like boiled egg white (Figure 2)。 Pathological macroscopic view: The size of the free ball is 7 cm ×6 cm ×5 cm, the gray-white matter of the section is tough, and a hard nodule is seen in the center, with a diameter of 1 cm. Postoperative pathological diagnosis: (1) Acute suppurative appendicitis; (2) Calcified nodules in the abdominal cavity, local with fibrosis.