腹痛伴腹水为主要症状的罕见原发性小肠印戒细胞癌1例及文献复习  

Primary signet ring cell carcinoma of the small intestine with abdominal pain and ascites as main symptoms:A rare case report and literature review

作　　者：王如意 武剑 顾页 范震 Ru-Yi Wang;Jian Wu;Ye Gu;Zhen Fan(The Forth Clinical Medicine College,Zhejiang Chinese Medical University(Hangzhou First People’s Hospital),Hangzhou 310053,Zhejiang Province,China;Department of Pathology,Affiliated Hangzhou First People′s Hospital,School of Medicine,Westlake University,Hangzhou 310006,Zhejiang Province,China;Department of Gastroenterology,Affiliated Hangzhou First People′s Hospital,School of Medicine,Westlake University,Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province,Hangzhou Institute of Digestive Diseases,Zhejiang Provincial Key Laboratory of Clinical Oncology Toxicology and Pharmacology,Hangzhou 310006,Zhejiang Province,China)

机构地区：[1]浙江中医药大学第四临床医学院(杭州市第一人民医院),浙江省杭州市310053 [2]西湖大学附属杭州市第一人民医院病理科,浙江省杭州市310006 [3]西湖大学附属杭州市第一人民医院消化内科,浙江省中西医结合胆胰疾病重点实验室,杭州市消化疾病研究所,浙江省临床肿瘤毒理药理重点实验室,浙江省杭州市310006

出　　处：《世界华人消化杂志》2024年第11期851-858,共8页World Chinese Journal of Digestology

基　　金：杭州市卫生科技计划重点项目,No.ZD20240015.

摘　　要：背景原发性小肠腺癌(small bowel adenocarcinoma,SBA),是极为罕见的消化道恶性肿瘤,其中小肠印戒细胞癌更加少见,属于SBA的一种.据流行病学研究统计,SBA仅占所有消化道恶性肿瘤的2%-3%,早期阶段病情隐匿,极易漏诊或误诊,临床医生需进行深入鉴别方可确诊.病例简介本文描述了一例罕见的SBA患者,以慢性腹痛伴腹水为主要症状,最后通过体外腹部超声引导下经皮腹腔内靶点穿刺获取组织病理并行免疫组化而确诊.并通过基因检测,选择个性化免疫治疗,随访患者4个月,患者因原发病去世.结论本文通过对此病例的诊疗分析及文献复习,强调了对SBA伴发腹痛、腹水的深入诊断和及时治疗的重要性,有望增加临床医生对SBA的整体认识,以期提高临床医生对此类罕见疾病的临床诊断水平.BACKGROUND Primary small bowel adenocarcinoma(SBA)is an extremely rare malignant tumor of the digestive tract.Small bowel signet ring cell carcinoma,a form of SBA,is even more rare.According to epidemiological statistics,SBA only accounts for 2%-3%of all gastrointestinal malignancies,and the disease is hidden in the early stage,which is easy to miss or misdiagnose,and clinicians need to conduct in-depth identification before diagnosis.CASE SUMMARY This paper describes a rare case of SBA,characterized by chronic abdominal pain with ascites as the main symptoms,which was finally diagnosed by histopathology and immunohistochemistry obtained through percutaneous intraperitoneal target puncture guided by external abdominal ultrasound.Through genetic testing,personalized immuno-therapy was selected.The patient was followed for half a year,and no symptoms such as abdominal pain and ascites were found.CONCLUSION The present case stresses the importance of in-depth diagnosis and timely treatment of SBA accompanied by abdominal pain and ascites,which is expected to increase the overall understanding of SBA and improve the clinical diagnosis of this rare disease.

关 键 词：小肠腺癌 慢性腹痛 腹水 鉴别诊断 免疫组化 

分 类 号：R735.32[医药卫生—肿瘤]