2025年 · 第40卷第04期

The 18-year-old female complained that "the sacrococcygeal mass was found for more than 1 year. It gradually increased 3 weeks ago, accompanied by redness, swelling and pain". Physical examination: There were no external hemorrhoids or warts around the anus, and a tumor of 3 cm ×3 cm ×2 cm in size was visible on the sacrococcygeal skin. The skin was intact without ulcer, the skin was red and swollen, soft in texture, the local skin temperature was slightly higher, and it was slightly tender. Digital rectal examination showed no abnormalities. Admission diagnosis: sacrococcygeal mass. Sacrococcygeal MRI revealed: sacrococcygeal subcutaneous mass, mucinous tumor (Figure 1)? Sacrococcygeal mass resection and flap transfer repair were performed. Preoperatively, the lesion resection area was designed and marked with a sterile marker pen (Figure 2). Intraoperatively, the tumor was completely removed until the sacral fascia, and the appropriate diamond flap was sufficiently freed, then transferred to cover the defect, and a hose drainage tube was placed under the flap for drainage (Figure 3). Postoperative pathological examination showed that (sacrococcygeal mass) was consistent with soft tissue ependymoma (Figure 4,5).

The patient, a 37-year-old female, was admitted to the hospital due to "weight gain for more than 5 years". The effect of weight control through diet and exercise is poor. Fifteen years ago, I underwent kidney transplantation due to "chronic kidney disease stage 5", and regularly took oral anti-rejection drugs after operation. I was diagnosed with diabetes 1 year ago and was not well controlled by oral medication. One month ago, my blood pressure was measured at 205/150 mmHg due to "headache", and my blood pressure was controlled at 150/110 mmHg after drug intervention. I went to the urology department for transplanted kidney biopsy. The results showed that malignant hypertensive kidney damage with diabetic nephropathy (type Ⅱb); Thrombotic microangiopathy lesions; Combined T cell mediated chronic rejection (grade I). Height: 160 cm, Weight: 91.2 kg, BMI: 35.6 kg/m²。 The preoperative diagnosis was: metabolic syndrome (severe obesity); Hypertension Grade 3, extremely high risk; Type 2 diabetes; hypertensive nephropathy; diabetic nephropathy; hypertensive retinopathy; Renal insufficiency after renal transplantation. Laparoscopic sleeve gastrectomy was performed, and the postoperative outpatient follow-up showed that the body weight, BMI, blood glucose and blood pressure were significantly improved at 1 month and 2 months after operation. During the short follow-up period, the patient's creatinine did not change significantly.

A 73-year-old male was admitted to the hospital due to "anorexia, melena for 1 month and fatigue for half a month". Physical examination: soft abdomen, mild tenderness under the xiphoid process in the upper abdomen, no rebound pain, and no mass in the abdomen. Gastroscopy showed an ulcer about 2.5 cm in size in the fundus of the cardia and stomach, covered with erosive necrosis, rough mucosa and involving dentate line. The abdominal CT scan showed thickening of the small curved lateral wall of the gastric cardia, and the enhanced scan showed obvious enhancement of the thickened gastric wall. Multiple enlarged lymph node shadows were seen paracardia and retroperitoneum, the larger one was about 3.2 cm ×1.9 cm, and the enhanced scan showed mild uniform enhancement (Figure 1). A rounded soft tissue nodule protruding into the lumen, approximately 2.5 cm in diameter, was seen in the middle abdominal small intestine, uniformly enhanced, and the adjacent intestinal wall was thickened (Figure 2). Radical total gastrectomy, esophagojejunal Roux-Y anastomosis + partial small intestine resection were performed. During the operation, the tumor was located in the anterior wall of the small curve of the cardia, with a size of about 3.0 cm ×3.0 cm ×0.6 cm. It invaded the submucosa, but did not invade the serosa layer, and the perigastric lymph nodes were enlarged and fused. The proximal small intestine was partially dilated, and a large amount of bloody content could be seen in the intestinal lumen. Hard and soft tissue nodules in size of about 2 cm ×1 cm and 3 cm ×2 cm could be seen in the small intestinal lumen about 30 cm and 35 cm away from Track's ligament, respectively. Postoperative pathological diagnosis: ① Gastric epithelioid angiosarcoma (Figure 3), invasion of submucosa, small curved lymph node metastasis (3/19); ② Jejunal epithelioid angiosarcoma (Figure 4) (2 foci, 1 foci invading the whole thickness and 1 foci invading the submucosa). Immunohistochemical examination showed that CK (weak +), Vim (+), LCA (-), CEA (-), CD31 (+) (Figure 5), CD34 (vascular +), F1i-1 (+) (Figure 6), ERG (+), CD117 (-), Ki67 positive cell count 40%. After half a year follow-up, the patient died due to extensive metastasis of the tumor.

An 82-year-old male was admitted to the hospital mainly for "abdominal distension, abdominal pain with anal defecation and reduced exhaust for 6 d". Physical examination: abdominal swelling, periumbilical and right abdominal tenderness, unpalpable rebound pain and muscle tension. Abdominal CT examination showed thickening of the wall of the ascending colon, dilation of the intestinal lumen with fecal accumulation sign, and massive blood accumulation around the ascending colon (Figure 1). Surgical treatment was performed in the emergency department. During the operation, a large area of seromuscular layer was damaged in the whole segment of the ascending colon, with a large area of active bleeding on the surface (Figure 2), covered with a large number of blood clots, and there was about 1 200 ml of dark red bloody fluid in the abdominal cavity. Right hemicolectomy was performed, the transverse colon was dissected and closed in the proximal segment of the transverse colon, and the closure was embedded with suture in the seromuscular layer, and the ileum was dissected and closed 10 cm away from the ileocecal region for ileostomy. Postoperative pathological examination showed edema of the ascending colon wall, massive infiltration of eosinophils (>100/HPF) in the whole thickness of the intestinal wall, with a small amount of lymphocytes and plasma cells (Figure 3). Pathological diagnosis: consistent with eosinophilic colitis. The absolute value of eosinophils in routine blood examination was 11.25×10⁹/L, the percentage of eosinophils was 46.3%. Methylprednisolone was administered intravenously at 20 mg/d, and the absolute eosinophil value was reduced to the normal range before discharge. Oral prednisone 30 mg/d was continued after discharge with a reduction of 5 mg every 10 days until discontinuation. Blood routine was reviewed regularly in the outpatient clinic after operation (once/month). There was no recurrence after 3 months, and the fistula was repaired electively.