这是一个52岁的印度女士出现吐血的案例,严重贫血,心脏衰竭的腹部肿块.关于射线照相评估,病变似乎是周围不对称的近端胃壁增厚,怀疑胃淋巴瘤或结核性肥厚性胃炎。多次输血稳定后,她接受了近端D2胃切除术,食管-胃吻合和全脾切除术。严重的,胃皱褶似乎肥大而结实。没有明显的增长;然而,在远端发现坏死区域。研究的多个切片的显微镜检查显示显著的小窝增生,曲折的腺体,和一些膀胱扩张的中央凹腺体,仅限于肌肉层。可见轻度浆膜充血。未见异型或侵入。要考虑的印象是Ménétrier病(MD)的可能性。MD是一种获得性蛋白质丢失性肠病,伴有巨大的胃皱褶,酸分泌减少,和增加胃粘膜的产生。射线照相,内窥镜,严重的是,这种情况可能与恶性淋巴瘤或癌相混淆。很难诊断,和切除标本的组织病理学确认需要明确的诊断。我们提出这种情况的目的是强调MD可以表现为大量呕血,应在鉴别诊断中予以考虑。对于持续性患者,建议通过全胃切除术或部分胃切除术进行手术治疗。使人衰弱的症状或患癌症的风险。
This is the
case of a 52-year-old Indian lady who presented with
hematemesis, severe anemia, and an abdominal lump in cardiac failure. On radiographic evaluation, the lesion appeared to be gross circumferential asymmetric proximal gastric wall thickening, with suspicion of gastric lymphoma or tubercular hypertrophic gastritis. After stabilization with multiple transfusions, she underwent proximal D2 gastrectomy with esophago-gastric anastomosis and a total splenectomy. Grossly, the gastric rugae appeared to be hypertrophied and firm. No growth was identified grossly; however, necrotic areas were identified at the distal end. Microscopic examination of multiple sections studied showed significant foveolar hyperplasia, tortuous glands, and a few cystically dilated foveolar glands, which were limited up to the muscle layer. Mild serosal congestion was seen. No atypia or invasion was seen. An impression to consider is the possibility of Ménétrier\'s disease (MD). MD is an acquired protein-losing enteropathy with giant gastric rugal folds, decreased acid secretion, and increased gastric mucous production. Radiographically, endoscopically, and grossly, the condition can be confused with malignant lymphoma or carcinoma. It is difficult to diagnose, and histopathological confirmation of the resected specimen is needed for a definitive diagnosis. Our intention in presenting this
case is to emphasize that MD can present as massive
hematemesis and should be considered in a differential diagnosis. Surgical treatment by total or partial gastrectomy is recommended for cases with persistent, debilitating symptoms or a risk of cancer.