Jejunal smooth muscle sarcoma: 20-day history of a mass, size larger than a goose egg. The patient reports pain in the right lower quadrant since the onset, which has been persistent. Accompanying symptoms include fever and night sweats, but no nausea, vomiting, or pus and blood in stool. In the past week, the pain in the right lower quadrant has worsened, with the nature of the tumor growth causing dull pain. There is no fever, loss of appetite, weight loss, or weakness, though there is some abdominal distension; however,排气and defecation remain normal.
Examination: Temperature 36.5°C, Pulse 80/min, Blood Pressure 16/11 kPa. General appearance is good, slightly thin with anemic appearance. Cardiopulmonary examination shows no abnormalities. Abdomen is flat without visible gastrointestinal patterns or peristaltic waves. No abdominal wall varices are observed. Liver and spleen not palpable. Abdomen is soft with no tenderness or rebound tenderness. A 4.0cm x 5.0cm mass is palpable in the right lower quadrant, with a smooth surface, medium-hard consistency, and mild tenderness. Shifting dullness is negative. Bowel sounds are hyperactive.
Laboratory tests: Hb 120g/L, RBC 4.0x10^12/L, WBC 6.2x10^9/L, L 36%, N 64%, K 5.0mmol/L, Na 140mmol/L, Cl 98mmol/L, Ca 2.3mmol/L, BUN 3.4mmol/L, Zinc turbidity 10 units, Musk turbidity units, reaction negative. GDT is normal, jaundice index 4 units, AlZd ~ 14 disc's unit, AFP negative. Chest X-ray shows no abnormalities. B-ultrasound reveals a 6.8cm diameter mass in the right lower quadrant with unevenly distributed echoes, seemingly separable, and with neat margins around it.
Barium enema shows poor filling at the ileocecal region, with a large filling defect in the cecum resembling a chicken egg, and a palpable mass. One week after the initial barium enema, another X-ray shows movement of the mass near the ileocecal region. Ileocecal junction is intact without exception. Probing suggests seepage off the ileocecal tumor.
Six days after admission, laparotomy was performed. Intraoperative findings: Normal abdominal cavity, small amount of fluid tail length 6.0 cm, tip diameter 3.0 cm. Reported by the Ministry as increasingly thick, violating the ileocecal department and appendix to form a mass about 6.0 x 7.0 cm. Direct observation shows grayish-yellow tumor at the appendix root with a diameter of 4.5 cm, hard and tough, surrounding tissue violation with clear boundaries promoting in the ileum membrane visible 0.2 x 0.5 cm lymph node. Surgical leisure to win management next considers ileocecal tumor 5 cm from the tumor line ileocecal part results drying removal of rebound-side anastomosis. Postoperative pathology report: Carcinoid tumor with mesenteric lymph node metastasis.
Discussion:
Reasons:
(1) Low incidence: Illustrates that appendiceal carcinoid tumors are one of the swellings that have increased, making preoperative diagnosis not high and even intraoperative diagnosis difficult. Especially in the vast majority of malignant tumors, surgical pathology or autopsy findings account for about 10% of the cases. Mu occlusion accounted for well appendectomy pocket relies mainly on pathological examination. Statistics from our hospital from 1985 to 1993 show 1525 appendectomies, with only 1 case of appendiceal cancer, accounting for 0.06%, thus making it difficult to obtain a clear diagnosis before surgery.
(2) Non-specific signs and symptoms: This suffering right lower quadrant pain in the right lower abdomen swollen matter exceeded the goose egg big fake right lower quadrant pain. Primary carcinoid tumors can occur in different parts of the appendiceal carcinoid only a comprehensive levy. As long as the alert t right lower quadrant pain anti-inflammatory treatment a bad turn significantly worse, and should take into account the appendiceal carcinoid. Furthermore, the general diagnosis of chronic appendicitis, but its history is longer, should take into account the appendiceal carcinoid. Prevent fishing out in postoperative certain pathological examination.
Treatment principle:
The key to treating appendiceal carcinoid is determining a definite diagnosis. The surgical approach should be appropriately chosen based on the lesion size. For lesions less than 1.0 cm in diameter with no invasion of the appendix serosa, simple appendectomy is sufficient. For diameters more than 2.0 cm with serosal invasion but no surrounding tissue transfer, ileocecal resection is recommended. If the tumor diameter exceeds 2.0 cm with plasma pancreatic involvement and surrounding tissue invasion, a right hemicolectomy is appropriate.
For frequency, urgency, north face wien, half-hearted pain, fresh hematuria half October examination showed no positive signs of the IUP and B ultrasound reveals bladder occupying lesions. Cystoscopy showed a cauliflower-like mass 2.0cm x 2.0cm x 1.5cm, sessile, wide base located 2cm above the right ureteral orifice. Clinical diagnosis of bladder tumor under epidural anesthesia underwent bladder tumor resection. Postoperative pathology report indicates glandular cystitis with mucosal interest within the kind of proliferation.
Discussion:
Levin pattern of cystitis glandularis is a special type of chronic cystitis. Clinically more common, yet the underlying mechanism is not yet clear. Very typical clinical manifestations make it not easy to identify with bladder neoplasms. Hematuria and bladder irritation symptoms are present.