2021年 · 第36卷第12期

The patient, a 70-year-old female, was admitted to hospital because "physical examination found that the liver occupied space for more than half a month". Physical examination: There was no palpable mass in the whole abdomen, no tenderness and rebound pain, and no palpable liver and spleen under the costs. Upper abdominal enhanced MRI showed two irregular abnormal signal shadows in the 6 segments of the liver, about 3.3 cm ×1.8 cm ×2.2 cm and 0.8 cm ×0.8 cm ×1.7 cm in size, with unclear boundaries, T₁WI showed low signal, T₂WI showed heterogeneous slightly high signal, DWI showed high signal, considering liver cancer; Irregular abnormal signal shadows were observed under the diaphragmatic surface of the 7th and 8th segments of the liver, with a size of about 4.3 cm ×4.0 cm ×2.7 cm, irregular edges and clear boundaries, T₁WI showed a slightly lower signal, T₂WI showed a non-uniform and significant high signal with a strip-shaped short T₁Long T₂Signal shadow, consider hepatic hemangioma (Figure 1）。 Liver tumor resection biopsy + omental tumor resection + intestinal adhesion release were performed. During the operation, more than ten vesicular tumors were seen in the 6th, 7th and 8th segments of the liver, which were gray-red, large in volume, with a maximum of about 3 cm ×3 cm ×2 cm, and soft in texture. A large number of tumors of the same type were seen on the omentum, and no obvious abnormalities were found in the spleen and uterine double appendages. Intraoperative frozen pathological examination of right liver mass and omentum mass showed thyroid follicular structure. Postoperative pathological examination showed thyroid follicular-like structures with different follicular sizes, glial visible in the follicular cavity, partial follicular dilatation, circular or quasi-circular nuclei of the follicular structure, delicate chromatin, and mitotic images are not easy to see (Figure 2）。 Immunohistochemical staining results: CK19 (+), TTF-1 (+), PAX-8 (+), E-Cadherin (+), Vimentin (+), CK7 (+), TPO (+), Thyroglobulin (+,Figure 3), CD56 (+), EMA (partial +), WT-1 (partial +), Galectin-3 (-), PR (-), ER (-), Syn (-), CgA (-), CK5/6 (-), Calretinin (-), D2-40 (-), BRAF (-), CEA (-), Ki-67<1% positive. Conform to ectopic thyroid tissue.

The patient was a 74-year-old female. He was admitted to hospital for 1 year due to the discovery of a lower abdominal wall mass. The patient had a history of sterilization 40 years ago. Physical examination: A tumor, about 3 cm ×2 cm in size, with mild tenderness and poor mobility, could be palpable 2 cm beside the scar of sterilization surgery in the middle right of the lower abdomen. Abdominal CT: A slightly high-density shadow was seen on the right anterior and lower abdominal wall with clear boundaries, and the lesion locally extended inward to the abdominal cavity, considering abdominal wall hernia (Figure 1）。 Surgical treatment was performed under epidural anesthesia. Intraoperative findings: 1 tumor in the subcutaneous fat layer was about 3 cm ×3 cm in size, soft and cystic. The exposed hernia ring is located in the white line, the hernia ring opening is about 0.5 cm, and the thread knot can be seen 2 cm below, which is the suture of previous sterilization surgery. One pedicle of the tumor continues with the abdominal cavity, and the hernia ring is released. There is also a tumor in the abdominal cavity, about 4 cm ×3 cm in size, which is cystic and continues with the tumor outside the abdominal wall (in the shape of a dumbbell) (Figure 2), the intraabdominal mass has a pedicle continuing to the bladder side, which is considered to be the formation of lineus albus hernia caused by urachal cyst, and urachal cyst resection + tension-free repair of abdominal wall lineus albus hernia is performed. The root of the pedicle was double ligated and cut off, and the dumbbell-shaped mass inside and outside the abdominal cavity was completely removed. The white line defect was closed by continuous suture with long-lasting absorbable thread, and the polypropylene patch was placed in front of the anterior rectus abdominis sheath for repair and reinforcement (onlay). The 2-0 thread was fixed, and the incision was closed layer by layer. Postoperative pathology: The cyst wall was covered with a single layer of cubic epithelium, which was consistent with the diagnosis of urachal cyst. After 3 months follow-up, neither the urachal cyst nor the line albus hernia recurred.

The patient, a 70-year-old female, was admitted to our hospital on 16 October 2018 due to acute biliary pancreatitis. The previous medical history is not special. Physical examination: tenderness in the middle and upper abdomen, no obvious mass palpable in the abdomen. Test: HIV antibody negative. Abdominal enhanced CT (Figure 1): Exudative changes around the pancreatic head, a solid mass shadow was seen retroperitoneally below the pancreatic head, with a CT value of about 37 HU, a size of about 4.3 cm ×4.2 cm, and spotty calcification was seen inside. After enhancement, it was obviously enhanced, with a clear border, and continuous enhancement in the delayed phase. Considering ganglionoma? Retroperitoneal tumor resection + cholecystectomy was performed on October 29, 2018. The operation was performed through the right toldt's space approach. The mass was found to be located retroperitoneally, inside and below the right renal hilum, with the upper boundary immediately adjacent to the level of the duodenum, and the inner boundary and posterior boundary immediately adjacent to the abdominal aorta and inferior vena cava. The boundary was clear, there was no vascular invasion, and the resection was complete. Postoperative pathology: lymph node Castleman disease (CD), hyaline vessel type. HE staining (Figure 2) showed that the germinal center of lymphoid follicles was atrophied under the microscope, small blood vessels with hyaline degeneration penetrated the follicles, the outer mantle layer was obviously thickened, and lymphocytes arranged in concentric circles formed an "onion skin"-like structure. The patient recovered well and was discharged from the hospital. There was no recurrence after 3 years of follow-up.