前列腺癌肺转移一例误诊并文献复习  

Misdiagnosis of One Patient with Prostate Cancer and Pulmonary Metastasis and a Literature Review

作　　者：刘军灵[1] 谢晓冬[1] 郑振东[1] 韩涛[1] 刘玉辉[1] LIU Jun-ling XIE Xiao-dong ZHENG Zhen-dong HAN Tao LIU Yu-hui(Department of Oncology, Cancer Center for Di- agnosis and Treatment of PLA, General Hospital of Shenyang Military Area Command, Shenyang 110016, China)

机构地区：[1]沈阳军区总医院全军肿瘤诊治中心肿瘤科,沈阳110840

出　　处：《临床误诊误治》2016年第12期35-38,共4页Clinical Misdiagnosis & Mistherapy

基　　金：2015年辽宁省自然科学基金(2015020408)

摘　　要：目的探讨前列腺癌的诊断要点及误漏诊原因。方法对酷似原发性肺癌的前列腺癌1例的临床资料进行回顾性分析,并复习相关文献。结果本例因轻度腹胀、左膝关节疼痛1月余,发现右肺占位性病变1周,双下肢麻木3 d入院。外院腹部CT检查示盆腔淋巴结增大;胸部CT示右肺门及右肺上叶占位性病变,考虑肺癌。入我院后在CT引导下行经皮肺穿刺活组织病理检查,术后病理报告:前列腺来源的转移性腺癌。行胸腰椎MRI示椎体多发转移瘤。超声检查示前列腺增生。查血前列腺特异性抗原(PSA)>300 ng/ml。确诊为前列腺腺癌Ⅳ期(c Tx N0M1)、肺多发转移癌、多发骨转移癌,予比卡鲁胺联合戈舍瑞林治疗。病程中患者出现双下肢软瘫,转外科行手术治疗,术后10个月随访,查血PSA正常,双下肢运动功能尚未完全恢复。结论前列腺癌易发生骨及肺转移,接诊肺及骨肿瘤的老年男性患者应考虑是否为前列腺癌转移,尽早行相关检查,避免误漏诊。Objective To investigate diagnosed points and causes of misdiagnosis and missed diagnosis of prostate cancer. Methods Clinical data of I patient with prostatic carcinoma like as primary lung cancer was retrospectively analyzed, and related literature was reviewed. Results The patient was admitted for slightly abdominal distension and pain in left knee joint for 1 month, the right pulmonary occupying lesion for 1 week and both lower limbs numbness for 3 d. Abdominal CT ex-amination showed pelvic lymph node hyperplasia, and chest CT showed space-occupying lesions in hilum of right lung and right upper lobe, and then lung cancer multiple pulmonary and renal metastatic tumors considered in other hospital. Percuta-neous pulmonary puncture biopsy was performed by CT guidance after admission in our hospital, and pathological findings sug-gested metastatic adenocarcinoma from the prostate. Thoracolumbar spine MRI showed multiple metastatic tumors of vertebral body. Ultrasonography examination showed benign prostatic hyperplasia, and serum prostate specific antigen （ PSA） was more than 300 ng/ml. Prostate cancer Ⅳperiod （cTxN0M1） multiple pulmonary and renal metastatic tumors confirmed, and then Bicalutamide combined with Goserelin was given. Soft paralysis of both lower extremities occurred in course of the disease, and the patient was given surgery treatment. PSA level was normal, but motor function of both lower limbs was not recovered totally for the patient in postoperative 10 months of follow-up. Conclusion Prostate cancer is prone to bone and lung metasta-sis, so clinicians should consider prostate cancer metastasis for elder patients with lung and bone tumors, and related examina-tions should be performed as early as possible in order to avoid misdiagnosis and missed diagnosis.

关 键 词：前列腺肿瘤 肿瘤转移 误诊 肺肿瘤 

分 类 号：R737.25[医药卫生—肿瘤]