2025年 · 第40卷第02期

The patient was a 67-year-old male. He was admitted to hospital because "physical examination found that the abdominal cavity occupied space for more than 1 month". Abdominal B-ultrasound showed that the anterior medial cystic space of the right kidney occupied 41 mm ×40 mm, considering the possibility of intestinal origin. Abdominal enhanced CT examination showed: liver-kidney space occupied, 55 mm ×37 mm in size, smooth edge, progressive enhancement after enhancement (Figure 1), imaging diagnosis considered gastrointestinal stromal tumor? Solitary fibrous tumor Neurogenic tumors?. The serum CEA, AFP, CA19-9 and CA125 were all normal after admission. The preliminary diagnosis was that the abdominal cavity occupied space and duodenal stromal tumor was possible. Retroperitoneal tumor resection was performed. Intraoperative exploration revealed a tumor with a diameter of about 50 mm ×50 mm near the descending part of the duodenum. It was isolated and had no relationship with the duodenum and pancreas. One nourishing blood vessel originated from the pancreas. The tumor had a clear border, enveloped and movable. Postoperative pathological specimens showed that the size of the tumor was about 50 mm ×40 mm ×30 mm, the capsule was intact, and the gray-white matter of the section was tough (Figure 2). Pathological examination revealed: (retroperitoneal) leiomyoma (Figure 3). Immunohistochemistry showed: H-caldesmon (+), Desmin (+) (Figure 4), S-100 (focus +), CD117 (-), CD34 (-), Dog-1 (-), ki-67 (5% +). No tumor recurrence was observed after 32 months of follow-up.

A 42-year-old female was admitted with "systemic bone and joint pain for 3 years". Suffered from uremia and was on hemodialysis for 12 years. Serum parathyroid hormone (PTH) was 1 279 pg/ml, with hyperphosphorus and hypercalcemia. Secondary hyperparathyroidism was diagnosed and total parathyroidectomy was performed. Four glands were surgically removed without parathyroid transplantation, and the postoperative pathological diagnosis was 4 parathyroid hyperplasia. Serum PTH was 1 667, 1 619, 1 493 and 1 601 pg/ml before operation, 15 min after operation, the second day after operation and before discharge. The patient's bone pain symptoms did not relieve. The patient was readmitted after 2 and a half months due to "bone pain". Serum PTH was 1 764 pg/ml. Enhanced CT examination of the neck showed a nodular focus about 1.5 cm in diameter behind the right sternoclavicular joint and in front of the brachiocephalic vein, considering the possibility of parathyroid adenoma (Figure 1). This ectopic functional gland was preoperatively localized in the retrosternal region. Through the original incision approach, the brachiocephalic trunk and right subclavian artery were explored to be palpable, but the mass was not palpable. If it was extremely risky to continue the operation, the operation was ended. Six months later, the patient was re-admitted with a serum PTH of 2 669 pg/ml. Parathyroid nuclide scan showed nodules in mediastinal area 3A with enhanced biphasic nuclide distribution (Figure 2). The possibility of ectopic hyperparathyroidism was considered in combination with the medical history. Thoracoscopic exploration through the original incision approach was unsuccessful. Later, the yellow soft tissue in the mediastinum was removed through sternum. Pathological examination showed parathyroid cells in the upper mediastinal mass. Serum PTH was 3 887, 154.6, 13.64 pg/ml before operation, 15 min after operation, and the second day after operation. For hypocalcemia, calcium gluconate was pumped intravenously, supplemented by calcium oral administration. Chest CT was re-examined on the 26th postoperative day, and no tumor was found behind the right sternoclavicular joint. Serum PTH was 6.69 pg/ml, and serum calcium and phosphorus were normal.