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患者男,62岁。左颌下肿物一年,生长缓慢。进行性咽下困难半年,消瘦,食欲不振4个月。查体:一般状态佳,左颉下可触及一2.5cm×2.5cm肿物,表面光滑,质硬,活动良好。上腹压痛(+)。胃镜检查见:贲门小弯侧可见4cm×4cm溃疡性肿物,界线不清,活检病理诊为胃癌。全麻下行左颌下肿物切除,根治性近侧大部胃切除,联合脾及脾动脉干切除术。病理检查:胃贲门下小弯前壁可见cm:4.5×5.0×1.0溃疡,边缘堤状,质硬,大体形态为Bo-rrmann3型,切面灰白色,大小不等淋巴结21枚。镜下观察:癌组织呈低分化,弥漫浸润性生长,达浆膜下,淋巴结3/32转移,其中第1组淋巴结转移1/1,第3组1/5,第11组1/1。颌下肿物cm:2.5×
Male patient, 62 years old. The left submandibular mass grows slowly for a year. Progressive dysphagia for six months, weight loss, loss of appetite for 4 months. Physical examination: The general condition is good. A 2.5cm x 2.5cm tumor can be touched under the left armpit. The surface is smooth, hard, and well-moved. Upper abdominal tenderness (+). Gastroscopy findings: 4cm x 4cm ulcerated mass was visible on the small curve side of the cardia. The boundary was unclear. The biopsy pathology diagnosis was gastric cancer. Under general anesthesia, the left submandibular mass was resected, the radical proximal part of the gastrectomy was performed, and the spleen and splenic artery were resected. Pathological examination: The anterior wall of the small curve under the gastric cardia can be seen with a cm: 4.5 x 5.0 x 1.0 ulcer, with an edge bank, hard texture, a general morphology of Bo-rrmann type 3, grayish white sections, and 21 lymph nodes of different sizes. Under the microscope, the cancer tissues showed poorly differentiated, diffuse infiltrative growth, reached serosa, and metastasized 3/32 lymph nodes. Among them, lymph node metastasis was 1/1 in group 1, 1/5 in group 3, and 1/1 in group 11. Submandibular mass cm: 2.5 ×