Zhang Rui, Xia Li-Gang, Huang Kai-Bin, Chen Nan-Di
The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong Province, China.
World J Clin Cases. 2022 Mar 6;10(7):2253-2260. doi: 10.12998/wjcc.v10.i7.2253.
Plexiform fibromyxoma (PF) is a rare mesenchymal tumor, with limited case reports worldwide. Common clinical symptoms are abdominal discomfort and bleeding signs, which frequently present slow-onset in reported cases. Herein, we report a case of gastric PF presenting as acute onset and with pyemia accom-panying tumor rupture. We resected the tumor as well as the distal gastric, bulbus duodeni and gallbladder for treatment in emergency surgery. Notably, before the onset of the disease, the patient received coronavirus disease 2019 (COVID-19) vaccines.
A 26-year-old man was admitted to our hospital, due to abdominal pain and fever after having received COVID-19 vaccines. Laboratory examination indicated severe sepsis. Computed tomography scan revealed a large mass in the abdomen. Deformation of the gastrointestinal tract was seen during gastroscopy. After failure of anti-infective treatment and symptoms of shock developed, he received an emergency surgery. We found a huge and partly ruptured mass, with thick purulence. Microscopically, the mass was composed of spindle cells with clarified cytoplasm, accompanied by myxoid stroma and arborizing blood vessels. Immunohistochemistry showed the tumor cells as positive for smooth muscle actin and succinate dehydrogenase subunit B but negative for DOG-1 and CD117. Finally, the patient was diagnosed with gastric PF and discharged from the hospital.
Gastric PF manifesting as tumor rupture combined with pyemia is rare. Timely surgery is critical for optimal prognosis.
丛状纤维黏液瘤（PF）是一种罕见的间叶组织肿瘤，全球范围内病例报道有限。常见临床症状为腹部不适和出血征象，在已报道病例中多表现为起病缓慢。在此，我们报告一例表现为急性起病且伴有肿瘤破裂致脓毒症的胃PF病例。我们在急诊手术中切除了肿瘤以及远端胃、十二指肠球部和胆囊以进行治疗。值得注意的是，在疾病发作前，该患者接种了2019冠状病毒病（COVID-19）疫苗。
一名26岁男性因接种COVID-19疫苗后出现腹痛和发热入院。实验室检查提示严重脓毒症。计算机断层扫描显示腹部有一巨大肿块。胃镜检查时可见胃肠道变形。抗感染治疗失败且出现休克症状后，他接受了急诊手术。我们发现一个巨大且部分破裂的肿块，伴有浓稠脓液。显微镜下，肿块由胞质清亮的梭形细胞组成，伴有黏液样间质和分支状血管。免疫组化显示肿瘤细胞平滑肌肌动蛋白和琥珀酸脱氢酶亚基B呈阳性，但DOG-1和CD117呈阴性。最终，该患者被诊断为胃PF并出院。
表现为肿瘤破裂合并脓毒症的胃PF较为罕见。及时手术对获得最佳预后至关重要。
