少见部位转移为首发症状的肺癌3例临床分析  

Clinical analysis of lung cancer with metastasis of rare parts as the first symptom： a report of three cases

作　　者：乔华[1] 张向宁[1] 姜尧[1] 董绍臣[1] 于鸿敏[1] 胡建秋[1] 

机构地区：[1]秦皇岛市第一医院呼吸科,066000

出　　处：《国际呼吸杂志》2016年第15期1137-1141,共5页International Journal of Respiration

摘　　要：目的提高对少见部位转移为首发症状的肺癌患者的诊治水平。方法对3例已经明确诊断的少见部位转移为首发症状的肺癌患者的临床资料进行分析，并结合文献复习。结果3例肺癌患者转移的首发症状分别为视物不清——肺腺癌脉络膜转移，多饮、多尿、烦渴——肺腺癌垂体转移，背部肿块——肺鳞癌骨骼肌转移，均为临床少见部位转移。脉络膜转移癌的诊断主要依靠临床症状和影像学检查，影像学包括眼部超声、眼底荧光造影、眼眶CT或核磁，必要时行细针活检。垂体转移肿瘤鞍区MRI呈哑铃样改变，中老年新出现的中枢性尿崩症，应该寻找可能的原发肿瘤。脊柱旁骨骼肌转移表现为疼痛的肿块，诊断可行肌肉超声和MRI确定肿瘤的大小，确诊需行细针穿刺。结论临床上应加强对少见部位转移为首发症状的肺癌的认识，详细询问病史并结合临床检查及病理，才能获得正确诊断及治疗。Objective To improve the diagnostic level of lung cancer with metastasis of rare parts as the first symptom. Methods The clinical data of three cases of lung cancer with metastasis of rare parts as the first symptom were analyzed and the literatures were reviewed. Results The first symptoms of the three patients were as follow：blurred vision-choroidal metastasis （CM） of lung adenocarcinoma, polydipsia, polyuria, dipsosis- pituitary metastasis （PM） of lung adenocarcinoma, dorsal tumor-paravertebral muscle metastasis of lung squamous-cell carcinoma. The diagnosis of CM depended on clinical symptoms and imaging including ocular ultrasound, fundus fluorescenee angiography, orbital CT or MRI, needle aspiration biopsy if necessary. The MRI imaging of PM lesion in sellar region was dumbbell lesion. If the aged patients were diagnosed the central diabetes insipidus firstly, the etiology should be found. The symptom of paravertebral muscle metastasis was painful mass, it was diagnosed by muscular ultrasound and MRI, definite diagnosis depended on fine needle aspiration biopsy. Conclusions The clinicians should strengthen the understanding of lung cancer with metastasis of rare parts as the first symptom, collect detailed medical history, physical examination and pathological finding, which can make correct diagnosis and therapy.

关 键 词：肺肿瘤 脉络膜转移 垂体转移 脊柱旁肌肉转移 

分 类 号：R734.2[医药卫生—肿瘤]