1 case of gastric hemangioma combined with renal vascular smoothy fibroids

Patient male, 61 years oldPatients with no obvious trigger setemptment searly symptoms of upper abdominal pain discomfort 3 weeks ago, intermittent colic, no nausea, vomiting, stool bloodThere were no obvious abnormalities in physical examination and laboratory examinationUltrasound gastroscopy: gastric angle - sinus mucous membrane visible uplift lesions, size of about 4.0 cm x 2.5 cm, top visible ulcers, lesions located in the inherent base, echo uneven, low echo-based, partial out-of-cavity growth, consider methysty tumors, neuroendocrine tumors to be dischargedCT scan: round soft tissue density shadow of the upper wall of the stomach sinuses, with a maximum cross-section of 3.9 cm x 2.6 cm, and the lesions grow simultaneously outside the cavity (Figure 1,5)Enhanced scanning arterial period, venous period and delay period were significantly strengthened, the average CT value was about 179HU, 151HU, 127HU, and the same period abdominal aortic density is close to (Figure 2 to 4), the lesions are supplied by the abdominal stem branch, around the large drainage veins (Figure 6,7), consideringvascularsource tumor or endocrine tumorfigure 1 gastric sinus soft tissue lumps, which see small strips of calcification, figure 2 to 4 stomach sinuses of the third stage of the lumps are significantly strengthened, and abdominal aortic strengthening density is similarAt the same time, Figure 4 is a mixed density lesions, which contain fat components, Figure 5 coronary reconstructed shows that the stomach sinuses significantly enhance the lesions, while protruding into the cavity and inside and outside, Figure 6, 7CT volume reproduction (VR) and maximum density projection (MIP) shows that the stomach GT is supplied by the abdominal stem branch Blood, around the large drainage veins into the intestinal membrane vein
seen in the operation: the tumor is located in the stomach corner, about 3.0 cm x 3.0 cm, has invaded the pulp membrane, the surgery is considered forgastric cancer, the root treatment of the far end of the large part of the gastric excisionPathology: small cell tumor under the gastric mucous membrane, tumor is immersed growth, invasion to the deep muscle layer, size: 4 cm x 2 cm x 2 cm, cut gray gray red, solid, in qualityImmunity grouped results: CK7 (-), CK (-), CD56 (-), CGA (-), Syn (C/ 31), CD31 (vascular), CD34 (vascular s), SMA (weak, Bcl-2), CD17 (-), CD17 (-), S-100 (-), CDX2 (-), CD99 (-), Vimentin (weak), LCA (-), CD21 (-), CD79a (-), CD3 (-), CD43 (-), Ki-67 (about 2% plus) diagnosis : gastric hemangioma discussion
hevama (glomus tumor, GT) comes from a small varicose venous matching structure that regulates skin temperature - angiosphere, a benign tumor-like hyperpluses that usually occur in the skin, dermatosphere, under the bed and at the end of the limbs, and is very rare in the stomach, accounting for only 1% of gastrointestinal tumors The GT wrapped around by normal cells is different from angioplasty cell tumor or cervical venous tumor Gastric GT is good at the stomach sinuses, are single hair, often occurred in the gastric mucosa layer, mucous membrane layer or slurry membrane layer, can also be located in the muscle layer Tumors can protrude from the stomach cavity, and the surface gastric mucosa can form with decay or ulcers CT flat sweep is shown as a soft tissue lump shadow under the mucous membrane, the boundary is clear, there is a envelope, the sphere is usually small, the diameter is generally not more than 3 cm, occasionally the lump is accompanied by speckled calcification, if there is an ulcer visible knot surface depression Because hemangioma contains vasometidcells and expanded irregular shape of thin-walled blood vessels, so blood supply is rich, CT-enhanced arterial period is edge-type or uniform significantly reinforced, venous period and delay period continue to be evenly reinforced, lesions of the enhancement curve is similar to the gate veins and lower cavity veins, and even with the lower aorta, while the enhancement of CT can also show the gastric GT blood supply and arterial drainage veins Its enhanced characteristics help to identify other mucous membrane lesions, such as methtomas, smooth fibroids, neuroendocrine tumors, etc Although the helical CT multi-stage enhancement scan can use multiplane reconstruction to accurately locate the gastric GT and show its vascular source and anatomical relationship, its reinforcement mode also has certain characteristics, but the diagnosis generally depends on pathology and immunohisic chemical analysis In addition, the application of ultrasound endoscope-guided fine needle piercing biopsy (endoscopicu ltrasound-fine needle, EUS-FNA) will be of great help to the diagnosis of tumors under the gastric mucosa before surgery, but due to the abundance of gastric GT blood supply, there is a risk of digestive hemorrhage, no reports have been reported in China, foreign Momohanty and Debol This example at the left kidney at the same time see a mixed density of fat and soft tissue components, by pathological biopsy confirmed as renal vascular smooth yosilioma, two swellings for different tissue sources of tumors, appear at the same level in the body, there is no correlation between the two Hemangiomas that occur in the stomach are rare, and this case is extremely rare in this case a gastric hemangioma combined with nephrlinesmooth fibroids