2025年 · 第40卷第12期

The patient was a 33-year-old female. The main cause was "abdominal distension for 1 month and aggravation for 1 d". Physical examination: A mass about 10 cm ×10 cm in size can be palpable on the right side of the abdomen, which is hard in texture, with poor mobility and no obvious tenderness. Abdominal CT examination revealed a space-occupying lesion on the right side of the abdominal cavity (Figures 1A, 1B). Three-dimensional visual reconstruction of the abdomen and pelvis showed that the soft tissue density-like tumor of the right lower abdomen and ileocecal region showed certain thick wall and surface nodule-like features. The appendix was closely adjacent to the tumor from the initial segment, and the tumor was adjacent to part of the cecal wall and ileal wall, and the blood supply of the tumor and appendix came from the right colon blood vessels (Figures 1C and 1D). Preoperative diagnosis: abdominal mass, considering the possibility of stromal tumor. Exploratory laparotomy was performed. During the operation, an irregular solid mass with a diameter of about 15 cm was seen in the right lower abdominal cavity, protruding from the back of the peritoneum to the abdominal cavity. The surface of the mass was closely related to the appendix, part of the cecal wall and the terminal ileum, and the mass was completely removed together with part of the cecum, part of the ileum and the appendix (Figure 2). The postoperative pathological diagnosis was high-grade extraosseous osteosarcoma (Figure 3). The results of postoperative immunohistochemistry showed: SATB2 (3+), CD99 (membrane +), Ki-67 (+40%), CD68 (scattered +), INI1 (+), TLE1 (1+), CD34 (-), SMA (-), Desmin (-).

A 73-year-old male was admitted for "progressive enlargement of paraaortic abdominal occupancy for 3 years". Previous history of hypertension, type 2 diabetes. Preoperative abdominal enhanced CT and arterial CTA examination showed that a mass about 9 cm ×6 cm in size was seen in the front and bifurcation of the lower abdominal aorta, with calcified margins, obvious enhancement in the arterial phase, and unclear boundaries with the inferior vena cava and right iliac vessels (Figures 1 and 2). Preoperative puncture pathological examination revealed poorly differentiated carcinoma, tending to urothelial origin. Retroperitoneal tumor resection was performed, and the tumor adhered tightly to the right common iliac artery, common iliac vein and inferior vena cava. The patient's blood pressure transiently increased to 220/120 mmHg during the process of free tumor, and the anesthesiologist administered an alpha-blocker (phentolamine) to reduce blood pressure. After the blood pressure stabilized, the tumor was removed, and tears of the right common iliac artery, common iliac vein and inferior vena cava were found. Then, the abdominal aorta and bilateral iliac vessels were blocked, and the tear of the right common iliac artery was sutured and repaired. Due to the extensive venous tear and difficulty in repair, the operation was ended after ligation of the inferior renal inferior vena cava and the right common iliac vein. Intraoperative bleeding was approximately 4 000 ml, and postoperative pathological diagnosis was retroperitoneal paraganglioma (Figure 3). Immunohistochemical examination revealed: Ki-67 (>5% in some places), S-100 (+), CgA (+), NSE (+), Vimentin (-); Silver staining result: negative. After operation, he was complicated by hemorrhagic shock, acute kidney injury and deep vein thrombosis of both lower limbs. After symptomatic and supportive treatment by the Department of Critical Care Medicine, he was improved and discharged from hospital. No tumor recurrence was observed after 22 months follow-up.

The patient, a 73-year-old female, was seen for "general fatigue with intermittent melena". Seven years ago, he underwent retroperitoneal laparoscopic radical right nephrectomy for "right renal cell carcinoma". Physical examination: No abnormalities were found. The test results on the day of admission showed: Hb 71.0 g/L, MCV 73.6 fl, serum albumin 37.9 g/L, total protein 61.4 g/L, weak positive fecal occult blood test, and no abnormalities in serum tumor markers. Abdominal enhanced CT showed irregular annular thickening of the descending and horizontal walls of the duodenum; Changes after right nephrectomy (Figure 1). Electronic endoscopy showed that a circumferential ulcer-type tumor was formed at the descending junction of the bulb, covered with purulent coating, congestion and edema on the surface, easy to bleed at touch, and the lumen was still unobstructed (Figure 2). Laparoscopic pancreaticoduodenectomy was performed, showing space-occupying lesions of the duodenum. The gross specimen is shown in Figure 3.

A 49-year-old male was seen for "mistakenly swallowing a dental file for 6 d". Physical examination showed: localized tenderness and rebound pain in the right lower abdomen, without obvious muscle tension. Laboratory tests showed that the proportion of neutrophils in peripheral blood was 84.7%. Total abdominal CT findings showed a lengthy appendix with a strip-like metallic dense shadow, approximately 3.1 cm long (Figure 1). The foreign body was removed under colonoscope and X-ray guidance through direct choledochoscope. There was no abnormality in the appendix opening during the operation, so foreign body forceps, stone removal net basket, stone removal balloon and other methods were attempted to remove the foreign body, but all failed. After endoscopic foreign body removal, total abdominal CT examination showed that the appendix was thickened, and the terminal shadow was dense with peripheral exudation and gas accumulation. An emergency laparoscopic appendectomy was performed, after which the appendix was opened and a foreign body, approximately 3.4 cm long, was removed (Figure 2). Postoperative histopathological findings showed acute appendicitis.