以右上臂肿物为首发表现的肺低分化腺癌1例与文献回顾  

A Case of Poorly Differentiated Lung Adenocarcinoma with Right Upper Arm Mass as the First Presentation and Literature Review

作　　者：卞亚南 李钊[2] 王法腾 

机构地区：[1]济宁医学院临床医学院,山东 济宁 [2]济宁医学院附属医院呼吸与危重症医学科,山东 济宁

出　　处：《临床医学进展》2024年第2期2699-2705,共7页Advances in Clinical Medicine

摘　　要：目的:通过1例罕见以右上臂皮下转移为首发症状的肺癌病例,指导临床医生及时确定原发部位,尽早做出正确诊断和个体化治疗,延长患者生存期。方法:回顾性分析该例肺低分化腺癌皮肤转移的临床特点、病理学特征、诊断及鉴别诊断、治疗及预后,并复习相关文献。结果:超声检查皮下见极低回声团块,胸部增强CT示左肺上叶尖后段不规则形分叶状肿块;右上臂肿物及左肺上叶活检病理均显示低分化腺癌,表现为一致的肿瘤细胞特征,结合免疫组化,证实右臂肿物癌是原发性肺腺癌的转移。行MDT后制定“培美曲塞二钠 + 卡铂全身化疗,贝伐珠单抗抗肿瘤血管”方案,经6个周期治疗后,患者右上臂及左肺上叶肿块较前缩小,皮下肿块疼痛减轻。结论:皮肤转移可能是肺癌的首发征象,尤其有长期大量吸烟史的患者,当皮肤病变迅速出现时,应考虑到肺癌伴皮肤转移可能。组织活检及免疫组化有助于精准诊断原发癌部位及组织学类型,含铂双药化疗联合抗血管治疗是有效的治疗选择。Objective: To investigate a rare case of lung cancer with subcutaneous metastasis of the right upper arm as the first symptom, guide clinicians to identify the primary site in time, make correct diagno-sis and individualized treatment as soon as possible, and prolong the survival of the patient. Meth-ods: The clinical features, pathological features, diagnosis, differential diagnosis, treatment and prognosis of skin metastases in this case of lung poorly differentiated adenocarcinoma were retro-spectively analyzed. Results: Very low echo mass was found subcutaneous by ultrasonography. Con-trast-enhanced CT showed irregular lobular mass in posterior segment of left upper lobe. The biop-sy pathology of the right upper arm mass and the left upper lobe of the lung showed poorly differ-entiated adenocarcinoma, showing consistent tumor cell characteristics. Combined with immuno-histochemistry, the tumor of the right arm was confirmed as metastasis of primary lung adenocar-cinoma. After MDT, the regimen of “Pemetrexed disodium + carboplatin systemic chemotherapy, bevacizumab anti-tumor blood vessels” was formulated. After 6 cycles of treatment, the masses of the patient’s right upper arm and left upper lobe of lung were smaller than before, and the pain of subcutaneous masses was relieved. Conclusion: Skin metastasis may be the first sign of lung cancer, especially in patients with a long history of heavy smoking. When skin lesions appear rapidly, the possibility of lung cancer with skin metastasis should be considered. Tissue biopsy and immuno-histochemistry can help to accurately diagnose the site and histological type of the primary cancer, and platinum chemotherapy combined with antivascular therapy is an effective treatment option.

关 键 词：肺腺癌 皮肤转移 软组织转移 吸烟 治疗 

分 类 号：R73[医药卫生—肿瘤]