腺癌多发转移合并Sister Mary Joseph结节  

A case of Sister Mary Joseph's nodule from multiple metastasis of adenocarcinoma

作　　者：师绍敏 毛燕 胡焕荣 冀雅聪 郭雷洋[1] 张艳丽 刘亚玲[1] SHI Shaomin;MAO Yan;HU Huanrong;JI Yacong;GUO Leiyang;ZHANG Yani;LIU Yaing(Department of Dermatology,Hebei Medical University Third Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院皮肤科,河北石家庄050051

出　　处：《临床皮肤科杂志》2024年第7期422-425,共4页Journal of Clinical Dermatology

基　　金：河北省自然科学基金(H2022206446)资助项目。

摘　　要：报告1例腺癌多发转移合并Sister Mary Joseph结节。患者男,49岁。脐部斑块、结节6个月,腰痛2个月。皮肤科检查:脐部一直径3.5 cm的淡红色浸润性斑块,表面可见多个直径1~5 mm淡红色丘疹、结节,簇集呈菜花样外观,质地坚韧,活动度差。CT检查示纵隔内淋巴结增大,腰3~腰5椎体等多处骨质破坏;锝亚甲基二膦酸盐(^(99m)Tc-MDP)全身骨显像示全身骨骼多处异常放射性浓聚灶。皮损组织病理检查:表皮大致正常,真皮全层致密增生的胶原束间肿瘤细胞呈单个或条索状、列兵样排列,部分肿瘤细胞核大、深染,有明显异形性。免疫组化:细胞角蛋白(CK)、CK7、绒毛蛋白(villin)均阳性表达。腰4椎体针吸组织病理检查符合转移性腺癌,免疫组化示CK及低分子质量细胞角蛋白(CAM)5.2均阳性表达。诊断:腺癌多发转移合并Sister Mary Joseph结节。治疗:患者拒绝接受治疗,随访至13个月时死亡。A case of Sister Mary Joseph's nodule from multiple metastasis of adenocarcinoma is reported.A 49-year-old man presented with umbilical plaque and nodules for 6 months,and lower back pain for 2 months.Dermatological examination revealed multiple variable-sized nodules in clusters on the top of an erythematous indurated plaque,which measured 3.5 cm in diameter,in the umbilicus.The lesions had poor mobility and were hard in texture.CT scan showed enlarged lymph nodes in the medi-astinum and multiple bone destruction especially in lumbar 3-5 vertebral bodies.The ^(99m)Tc-MDP whole body bone scan revealed focal and intense uptake in multiple bones.Histopathological examination showed a dense infiltration of atypical cells in single units and as cords in between collagen bundles involving the entire dermis.The overlying epidermis was unremarkable.Immunohisto-chemistry showed the tumor cells were positive for cytokeratin,CK7 and villin.Needle aspiration biopsy of the lumbar 4 vertebral body showed the changes consistent with metastatic adenocarcinoma,which was positively stained with cytokeratin and low molecular weight cytokeratin CAM5.2.A diagnosis of Sister Mary Joseph's nodule from metastatic adenocarcinoma was made.The patient refused medical treatment and died after 13 months of follow-up.

关 键 词：Sister Mary Joseph结节 腺癌 转移性 皮肤转移 骨转移 

分 类 号：R739.5[医药卫生—肿瘤]