副脊索瘤术后复发并肺和胰腺转移一例及文献复习  

Postoperative recurrence of parachordoma with lung and pancreatic metastasis: one case report and literature review

作　　者：何建明[1] 刘国鸿[2] 黄伟[3] 段鸿滨[4] 

机构地区：[1]韶关学院医学院附属医院普外科,韶关512026 [2]韶关学院医学院附属医院影像科,韶关512026 [3]汕头大学医学院附属粤北人民医院病理科,韶关512026 [4]汕头大学医学院附属粤北人民医院骨科,韶关512026

出　　处：《新医学》2015年第3期162-167,共6页Journal of New Medicine

摘　　要：目的分析探讨副脊索瘤术后复发及转移的特点及治疗效果。方法报道1例副脊索瘤术后复发及转移患者,以"副脊索瘤"以及"复发"或"转移"或"恶性"为检索词,对以下数据库的相关论文进行检索:生物医学文献数据库(MEDLINE)、美国国家生物技术信息中心(NCBI)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据知识服务平台,收集并分析检索到的副脊索瘤术后复发并转移患者的资料。结果该例为左外踝副脊索瘤男性患者,因左外踝外伤后出现肿块并逐渐增大而就诊,常规体格检查、实验室及辅助检查均无特异性,遂接受肿块切除术,术后经病理活组织检查(活检)及免疫组织化学检查(免疫组化)确诊为左外踝副脊索瘤。患者术后出现多次复发并广泛转移,先后接受了左小腿截肢及左半骨盆离断手术。复发及转移病灶对化学治疗不敏感,选用冷冻治疗+肿块内放射性粒子植入微创治疗曾获一定疗效,但总体疗效差,终因呼吸衰竭死亡,生存期59+个月。检索文献后收集到已被报道的副脊索瘤术后复发并转移的病例6例,病理诊断为低度恶性变的病例3例,均经病理活检(或加免疫组化)确诊,以局部扩大手术切除治疗为主,辅以化学或放射治疗,出现转移的患者中2例死亡。结论尽管副脊索瘤可通过手术完整切除,但其仍有复发和转移的可能,因此术后要密切随访并注意肿瘤是否有局部复发及远处转移,对出现复发或转移的患者应定期行多器官系统检查以密切监测肿瘤的进展。Objective To analyze the postoperative recurrence,metastatic characteristics and treatment efficacy of parachordoma. Methods One patient with postoperative recurrence and metastasis of parachordoma was reported in this study. Relevant literatures were searched out using the keywords of＂parachordoma＂and ＂recurrence＂or＂metastasis＂or＂malignant＂from MEDLINE,NCBI,CBM,CNKI and WANFANG databases. Clinical data of postoperative recurrence and metastasis of parachordoma were collected and analyzed. Results The male patient had parachordoma in his left lateral malleolus. He was admitted to our hospital with complaints about a gradually enlarging mass after the left lateral malleolus trauma. Conventional physical examination,laboratory and accessory tests revealed no abnormality. Then,he underwent surgical resection of the tumor. He was diagnosed with left malleolus lateralis parachordoma confirmed by postoperative pathological biopsy and immunohistochemical examination. The patient experienced repeated recurrence and widespread metastasis,and then received left lower extremity amputation and subsequently left hemipeivectomy. The recurrent and metastatic lesions were insensitive to chemotherapy. Although cryotherapy combined with minimally invasive intratumoral implantation of radioactive seed yielded some clinical efficacy,whereas the prognosis was poor. He died from respiratory failure with a survival time of 59＋months. Literature review reported 6 cases with postoperative recurrence and metastasis of parachordoma,3 cases were pathologically diagnosed with lowgrade malignant lesions,all patients were confirmed by pathological biopsy（ or plus immunohistochemical test）.Extended resection of locally enlarged tumors was adopted as the primary therapy,assisted by chemo- or radiotherapy. Among all patients with tumor metastasis,two cases died. Conclusions Although parachordoma can be completely resected surgically,the recurrence and metastasis of the tumor still exist. Consequently,topical recurrence and d

关 键 词：副脊索瘤 肺 胰腺 肿瘤 转移 

分 类 号：R738[医药卫生—肿瘤]