2024年 · 第39卷第06期

The patient, a 23-year-old male, was admitted to hospital for "discovering an abdominal mass for more than 20 years". At 6 months after birth, the patient underwent MRI examination due to "abdominal swelling" and found "huge abdominal mass". It was not treated at that time, and the tumor gradually grew. Abdominal MRI was performed at admission: cystic mass occupation, 34 cm ×18 cm size (Figure 1). Surgical treatment was performed. During the operation, a huge cystic mass in the abdominal cavity was found, and about 4 000 ml of brown-green turbid liquid was aspirated by decompression. One end of the mass was blind, and the other end was closely related to the ascending colon and terminal ileum. During the operation, the diagnosis of duplication of digestive tract was possible. The mass, appendix, and part of the ileum with severe adhesion to the mass were completely removed (Figure 2). The patient was reoperated on the first day after operation due to abdominal hemorrhage, and the bleeding site was found to be the mesileal vessel, which was sutured. The patient recovered smoothly after the second operation and was discharged on the 11th postoperative day. Postoperative pathological examination: "The dilated stomach wall tissue and a little esophageal wall tissue conform to the duplication deformity of stomach and esophagus."

The patient was a 68-year-old female. Physical examination 5 months ago revealed "soft tissue mass at the outer edge of the great curvature of the stomach". Routine blood test: total number of white blood cells 12.1×10⁹/L, hemoglobin 65 g/L. Gastroscopy: cardia fundus mass, gastric perforation possible. Cardia biopsy revealed: moderately-poorly differentiated adenocarcinoma. Abdominal CT plain scan + enhanced examination: huge exophytic mass in the fundus of the stomach, considering the possibility of gastric stromal tumor, mass gastric cancer to be ruled out (Figure 1). The patient had heavy tumor burden, gastric perforation and hemorrhage, and abdominal infection. He underwent total gastrectomy with esophagojejunostomy + pancreatectomy + splenectomy + partial transverse colonectomy + caudate lobectomy of the liver + common bile duct incision and lithotomy + T-tube drainage (Figure 2). Pathological examination: (1) mixed neuroendocrine-non-neuroendocrine neoplasms (MiMENs) of the stomach (small cell neuroendocrine carcinoma accounts for about 70%, mucinous adenocarcinoma accounts for about 30%) (Figures 3, 4), invading the outside of the serosa, involving the pancreas, caudate lobe of the liver, splenic hilum, transverse colon serosa surface, nerve invasion (+), vascular tumor thrombus (+); (2) Immunohistochemical results: Syn (weak +), CgA (-), CD56 (partial +), CK (+), CEA (local +), p53 (+), CK7 (-), INI1 (+), BRG1 (+), Ki-67 (+, about 80%). Follow-up for 3 months showed no tumor progression.

A 58-year-old male was admitted to the hospital due to "repeated epigastric pain and discomfort for more than 3 months, aggravated for 3 days". History of regularly taking aspirin anticoagulants and hypertension due to "true polycythemia" in the past. Physical examination: The abdomen was flat, the abdominal muscles were not rigid, and the whole abdomen was not palpable. Mild tenderness in the upper abdomen without rebound pain. Murphy sign (+). Laboratory test: blood routine: white blood cell count 17.18×10⁹/L, absolute neutrophil value 13.88×10⁹/L, platelet count 483×10⁹/L. Serum rapid C-reactive protein 15.2 mg/L and fibrinogen 4.8 g/L. Abdominal enhanced CT showed small cystic duct stones with multiple lesions in the left abdominal space, which were considered peritoneal lesions and were likely to be benign (Figure 1). Preoperative diagnosis: gallstones with cholecystitis, left peritoneal lesions. Selective laparoscopic cholecystectomy was performed and the left abdominal cavity was explored. During the operation, extensive multiple hemangiomas in the omentum of the left abdominal cavity were found and spread to the great curvature of the stomach, involving obvious tortuosity, dilation and congestion of some blood vessels in the great curvature of the stomach (Figure 2). Laparoscopic cholecystectomy + omentectomy + partial gastrectomy was performed. The macroscopic observations of the extracted specimens: 1 gray-yellow and gray-red omental gastric tissue specimen, the size is 14.5 cm ×9.0 cm ×3.2 cm, the gastric tissue size is 6.0 cm ×2.5 cm ×2.0 cm, and mucosal folds are present (Figure 3). Postoperative pathological examination: (Omental hemangioma and part of stomach) Hemangioma was seen in omental tissue, and vasodilation, congestion and hemorrhage were seen in the submucosal layer of gastric tissue (Figure 4).