crazy scalpel

This is not a meningioma, but a brain metastases!

Cancer cells metastasize from the primary lesion to the brain through blood, lymph or nerves, and secondary intracranial tumors are called metastatic tumors.

From the primary cancer to the formation of brain metastases, a very complex biological process is required, and human beings' understanding of this process is still being gradually improved through continuous research and exploration.Because this process is very complicated, generally speaking, the primary cancer is found first, and then the brain metastases are found.

There are also a small number of patients who find brain metastases first, and then find the primary cancer after examination.

There is also an even smaller proportion of patients whose primary cancer cannot be located.And now Pang Fu belongs to this minority.

Xie Ke guessed that the primary cancer may be in the lungs, because the hematogenous metastasis of primary tumors in general organs usually invades the venous system first, and most of them have to be filtered by the lungs, while the primary cancer of the lungs enters directly through the pulmonary veins arterial system.

The growth rate of lung cancer is very fast. Due to the insufficient blood supply, the tumor is prone to necrosis and falls off. In addition, the pulmonary blood vessels and lymphatic network are rich, and the lung cavity is constantly moving. These are easy to cause cancer cells to fall off and enter the blood circulation. Then along with the carotid artery or vertebrobasilar artery ascend to the intracranial metastases.

However, Pang Fu's lung tomography showed no signs, so he had to search slowly.

What should be done now is to arrange surgery immediately!

Generally speaking, brain metastases are already at an advanced stage of cancer, and craniotomy may not be a good choice.But Pang Fu's current situation is that no primary lesion can be found, that is to say, his survival period is still relatively optimistic, and his Karnofsky score is also very high.In addition, the whole body and head were searched, and only this one tumor was found, which was also conducive to surgical resection.

Xie Ke called Pang Da and Pang Tian to talk separately: "Many clues suggest that the tumor may be formed by the metastasis of cancer cells, but there is no particularly hard evidence to prove it. I suggest that a craniotomy be arranged immediately to remove the tumor During the operation, the tumor tissue can be taken for testing to find out whether it is true. If so, a comprehensive examination must be carried out immediately to find the real primary cancer focus.”

Taking tissue slices for testing is of course the best way.However, Xie Ke was extremely suspicious that the deputy director Bian had ignored the difference between cancer cell metastases and primary meningiomas when he removed the previous tumor.

If it is meningioma, the cut surface is generally moist, while the cut surface of cancer cell metastases is dry and rough, gray-white or gray-red, which is easy to distinguish.Pang Fu's tumor is relatively large, and there is likely to be necrosis and pus in the middle. It is impossible for Deputy Director Bian not to see it? !

Xie Ke quickly arranged Pangfu's operation on the third day, which was also his first major operation after returning to the inpatient department from the outpatient department.

After Bian Shunyuan heard Wen Xudong talk about this incident, he took the initiative to find Xie Ke.

"Xiao Xie, look at Pang Fu's operation, can I still do it?" Although Bian Shunyuan was a little uncomfortable, he still bit the bullet and made this request to Xie Ke.

For this kind of senior who is much higher than himself in terms of title and qualifications, Xie Ke has to be very tactful even if he refuses: "This... I have already promised the patient and family members, why don't you go and talk to them, if they If I choose you to do it, I will definitely have no problem here."

Bian Shunyuan put one hand on Xie Ke's shoulder, and said earnestly: "It's like this, last time I had an operation on Pang Fu, it was a meningioma. But I didn't expect another one to grow so soon , so it seems that this one is likely to be a metastatic tumor. The patients don't understand, so they will inevitably suspect that I didn't do it last time, and you are so popular now, it is normal for them to ask you to do it..."

Xie Ke: "By the way, Deputy Director Bian, I'm about to ask you for advice on this matter. When you removed the tumor last time, were you sure it was a meningioma?"

Bian Shunyuan paused uncomfortably, a little unhappy: "Of course it is, why, do you still suspect that I even got this wrong?"

Xie Ke: "No, don't get me wrong. I suspect that the metastatic tumor occurred in the primary tumor, that is, a metastatic tumor grew in the place where the meningioma was originally. This situation is not impossible, and It can't be seen from the film, it can only be found when the tumor is removed."

Xie Ke observed Bian Shunyuan's expression while talking, trying to find some clues, but Bian Shunyuan, as expected of an old fox, was not moved at all by Xie Ke's words, and instead praised him: "Xiao Xie, although you You are young, but I think the problem is really comprehensive, very good. Very good. Haha, there are talented people from generation to generation. If this is the case, then you should work hard on the operation. I will go first."

Bian Shunyuan didn't say for sure in the end whether what he removed was a meningioma. Of course Xie Ke couldn't fail to hear that he was changing the subject, but the more he did this, the deeper Xie Ke's doubts about him.

Back in his deputy director's office, Bian Shunyuan sat on the boss chair and turned around, sighing.Seeing him like this, Wen Xudong couldn't help but wondered: "Uncle, why do you care so much about that Pang Fu? According to my opinion, even if they entrust you with the operation this time, they won't give you so much money. Just Let Xieke do it, anyway, if he said it was meningeal cancer, it would be a thankless task."

"Hey, I said why did you get into the eyes of money? Is this a matter of money?" Bian Shunyuan pointed his fingers helplessly, "Be careful, look at Xie Ke, who is younger than you After half a round, how can this be a matter of money?"

Wen Xudong scratched his head, "What else can it be if it's not money? It's rare to see a monster like Xie Ke, why is he so powerful? Could it be the reincarnation of the white snake spirit?"

"..." Bian Shunyuan wished he could pry Xie Ke's and his nephew's heads off, and then replace them. Why is the gap so big?

Wen Xudong: "I said uncle, what's going on? Could it be that your meningioma was diagnosed by mistake?"

Bian Shunyuan took a look at him: "Weren't you my assistant at the time? You were the one who saw the most clearly during the operation except me. Didn't you find anything?"

Wen Xudong thought for a while and said, "Nothing special? I think the operation went well."

Bian Shunyuan shook his head, extremely disappointed with his nephew.The room was silent for a while, and Bian Shunyuan suddenly said, "I cut through that tumor."

"Oh, you said this." Wen Xudong remembered, "But it's nothing. Don't you want to pursue that one-size-fits-all like Xie Ke? Don't we usually cut it off little by little?"

Bian Shunyuan sighed, "If it's a meningioma, it really doesn't matter, but then... there was pus coming out of the middle, I didn't know what happened and I was dazed, and I didn't wash it off with normal saline in time. Maybe It’s because I didn’t expect it to be a metastatic tumor, I really misdiagnosed it.”

Most of the brain metastases are located in the brain parenchyma, but a few will metastasize to various locations in the brain, such as the meniscus, optic nerve, olfactory nerve, pituitary gland, pineal gland, etc., are all possible.However, it is indeed relatively rare for Ponfort to metastasize into the primary brain tumor.Not only is it rare, but it is also difficult to diagnose.

Wen Xudong didn't take it seriously at first, but after he figured it out, his mouth opened into an O-shape: "Oh my god, really? Uncle, you mean that the tumor that Pang Fu's new growth may be that pus..."

Bian Shunyuan nodded: "Yes, although the previous tumor was completely removed, Xie Ke is really a bit powerful. I was afraid that he would see something at that time, so I thought it would be best to take over the operation But now it seems that it is basically impossible. Brothers Pang Da and Pang Tian also seem to obey him and trust him very much."

In a hurry, Wen Xudong stood up, lowered his head, and walked back and forth in the office.

Bian Shunyuan was dazzled, and said to him: "Don't go away, okay, you are like a wolf. Forget it, God knows this, you know it, and you know it, so don't let it out. As for Xie Ke, it's okay Not a very talkative person, if he can cure Pang Fu, I will have less psychological burden."

Wen Xudong: "How can this be done? If Xie Ke finds out about this, wouldn't he have something against us? Last time he drove him to the outpatient clinic, it was impossible for him not to bear a grudge against us. Once he catches us with painful feet , Will he fight back? I don't believe it. Do you still remember that Zhong Liangquan? Just because I told him that Xie Ke's professional title was not high enough, didn't he get admitted to the attending doctor and did the operation? In this way, he still hated me, and even named me at the meeting to criticize me for not being familiar with the medicine and not knowing the dosage of the medicine.”

Bian Shunyuan didn't agree with him: "I don't think he hates you, but he's a bit too straightforward. If he really wants to take revenge on you, do you think you can still be so stable? Think about it, he and Xu Wanjin Liu Jianhong used him so much, and Cai Tianqiao treated him well. And even though Jing Haoran broke up with him, his own wife died, and he acted like nothing happened. He didn’t bother Xie Ke. Do you think Xie Ke is simple? ?"

Wen Xudong "cut", obviously not convinced.

Bian Shunyuan patted him on the shoulder, and said softly: "Although I can barely cover you in this department, you can't keep messing around like this anymore. You should mature sooner. To be honest, I, the deputy director, , it’s also tasteless.”

Wen Xudong nodded like pecking at rice: "Uncle, don't worry, I know. And Xie Ke, I will help you find a way, and I will leave this matter to me, and I will take care of it."

Bian Shunyuan smiled wryly: "What can you do. Don't talk about Xie Ke, because if you talk too much, it will easily arouse his suspicion. It stands to reason that it should not be discovered, after all, this is a new tumor now. It turns out that I cut it very cleanly, so I still have some confidence.”

Wen Xudong smiled "hehe", "I know, how can I be so stupid to make him suspicious. This time he is undergoing surgery, I will be his assistant, so that I can know in time if something happens. "