胆囊小细胞癌1例

胆囊小细胞癌罕见,具有独特的临床病理学特征,进展快,早期即可发生转移,预后差,好发于老年女性.临床研究表明其生物学行为及预后不同于小细胞肺癌,也不同于其发生部位的常见肿瘤,而有其独特的临床特征[1].2013年我院诊治1例,报道如下. 1 资料 患者女性,70岁,因反复右上腹疼痛3月余,呕吐1日,于2013年8月5日第1次来我科住院.查体:疼痛按数字分级评分法(NRS)评分为3分,左锁骨上可及一大小约1cm×2cm肿大淋巴结,质硬,活动差,无痛,其余浅表淋巴结未触及肿大,心肺无异常,腹部平软,腹正中可及一大小约2cm×2cm肿块,质中,有触痛,肝脾肋下未触及肿大,肠鸣音正常,移动性浊音阴性,双下肢无水肿,直肠指检未见异常.     

Small Cell Gallbladder Carcinoma Complicated by Paraneoplastic Hyponatremia: A Case Report and Literature Review

Introduction

Gallbladder carcinoma has been associated with various paraneoplastic syndromes. These may be the presenting manifestations that lead the clinician to a diagnosis.

Case Report

We report a case of small cell gallbladder carcinoma complicated by paraneoplastic hyponatremia. The hyponatremia was further exacerbated by platinum-based chemotherapy.

Discussion

There have previously been no reports of paraneoplastic hyponatremia in gallbladder carcinoma. We discuss the management of this problem and also provide a short literature review on the other paraneoplastic syndromes associated with gallbladder carcinoma.

Conclusion

Symptoms and signs of gallbladder cancer may be insidious. Thorough workup is needed if the patient presents with symptoms and signs of a paraneoplastic syndrome.     

食管小细胞癌误诊1例报道

患者,女,59岁.因吞咽哽噎感1个月,于2000年4月10日在外院行胃镜检查,结果示:食管距门齿25cm处右侧壁见一1.5cm×1.5cm之半圆形黏膜隆起,表面黏膜充血,活检3枚送检,质韧.     

子宫颈小细胞癌1例报道

患者王某，女性，39岁，因“接触性出血2个月”于2008年1月11日住入武汉大学人民医院妇科。患者平素月经规则，经量中等，色鲜红，无痛经，末次月经：2007年12月30日。近2个月来无明显诱因出现同房后出血，量少许，无腹痛、白带增多、腰骶部酸痛等不适。此前曾到他院就诊，阴道镜示：慢性宫颈炎，7°、11°处活检提示子宫颈神经内分泌癌。     

Response of Small Cell Carcinoma of Pancreas to a Small Cell Lung Cancer Regimen: A Case Report

Small cell carcinoma of the pancreas is a very rare malignancy with 18 cases reported in the literature, of which only 3 were treated with chemotherapy. A 52-year-old man was diagnosed with small cell carcinoma originating in the head of the pancreas and invading the duodenum. He was treated with a similar approach as for localized small cell lung cancer, with six cycles of combination chemotherapy and local radiotherapy, and went into complete remission. After 3 months, he developed liver metastases along with an enlarged left supraclavicular lymph node. He was treated with two cycles of CVA, but developed lung metastases and was treated with ifosfamide/mesna. However, his overall condition deteriorated and hospice care was instituted until the patient's demise. The patient survived 14 months following diagnosis, significantly longer than the 15 reported patients with small cell pancreatic carcinomas not treated with chemotherapy. Combination chemotherapy and radiation therapy as is utilized for small cell lung cancer appear to be beneficial for small cell carcinoma of the pancreas.     

胆囊癌肉瘤伴神经内分泌分化1例报道及文献复习

目的探讨胆囊癌肉瘤伴神经内分泌分化的临床病理学特征及诊断、鉴别诊断要点。方法对1例胆囊癌肉瘤伴神经内分泌分化进行临床病理分析及免疫组化研究。结果胆囊癌肉瘤伴神经内分泌分化临床上可以表现为腹部疼痛而体格检查阴性;镜下肿瘤组织由癌和肉瘤两种成分组成。癌细胞排列呈不规则腺样、点片状和巢状,部分区域呈实性。癌细胞有丰富的嗜酸性胞浆,异型明显,可见核分裂象。肉瘤成分梭形细胞丰富,排列呈束状,细胞异型明显,可见核分裂象。两种成分无移行现象。免疫组化:癌细胞CKL( )、CGA( )和Syn( ),Vimentin(-)。癌细胞神经内分泌标志阳性。肉瘤成份Vimentin( ),CKL(-)、CD117(-)和SMA(-)。结论胆囊癌肉瘤伴神经内分泌分化是一种罕见的恶性肿瘤,其诊断和鉴别诊断主要依靠病理组织学和免疫组化方法。     

Primary Small Cell Neuroendocrine Carcinoma of the Endometrium

Background

Small cell neuroendocrine carcinoma is very rarely encountered within the endometrium.

Case Study

A patient underwent a hysterectomy and salpingo-oophorectomy for a suspicious gynecologic condition. Pathology revealed invasive small cell neuroendocrine carcinoma of the endometrium; the neoplasm exhibited positive immunoreactivity for synaptophysin, pancytokeratin and CD56 but was negative for CD3 and CD20. Prior to chemotherapy, a completion lymphadenectomy was indicated to determine the presence of nodal metastases.

Conclusion

The prognosis of small cell neuroendocrine carcinoma of the endometrium is unfavorable but prompt detection with surgery and adjuvant therapy may confer a better clinical outcome.Key Words: Small cell neuroendocrine carcinoma, Endometrium, Gynecologic oncology     

胆囊癌并慢性粒细胞性白血病、脾亢1例

患者男性 ,５４岁 ,因右上腹痛２年加重１个月 ,于２０００年５月１５日入院。查体 :右上腹压痛 ,肝脾未及。Ｂ超 :胆囊体部后壁见一３．２ｃｍ×１．８ｃｍ实性强回声团块 ,脾脏增大 ,厚约５．６ｃｍ。血常规 :ＷＢＣ４．７×１０９／Ｌ,ＲＢＣ３．９７×１０１２／Ｌ,ＰＬＴ３２×１０９／Ｌ,乙肝五项阴性 ,肝功能正常 ,诊断 :胆囊肿瘤、脾亢。术前输入血小板１Ｕ ,于５月２３日全麻下行胆囊、脾切除术。病理检查 :胆囊大小８ｃｍ×５ｃｍ×０．３ｃｍ（剪开后量） ,体部见一簇菜花样肿物 ,大小２ｃｍ×１．３ｃｍ×１ｃｍ ,切面灰白色 ,…     

肝脏原发神经内分泌癌1例及文献复习

0引言肝脏原发性神经内分泌癌极为少见,我们在临床中遇见1例,今报告如下并复习文献,结合该病的发病特点、鉴别诊断、治疗方法、预后判断等作一讨论。     

Primary Small Cell Carcinoma of the Tonsil: A Case Report and Review of the Literature

Small cell cancer (SCC) of the tonsil is a rare and aggressive cancer. There are only 10 cases of tonsillar SCC reported in the English literature. We present a case of tonsillar SCC successfully treated with induction chemotherapy using carboplatin and etoposide followed by concurrent chemoradiation therapy with cisplatin as radiosensitizer. The patient remained free of recurrence after 3 years of follow-up. We also provide a succinct review of all tonsillar SCC cases reported in the English literature and their outcomes.Key words: Tonsillar cancer, Neuroendocrine tumor, Small cell cancer, Carboplatin, Etoposide     

宫颈小细胞神经内分泌癌临床病理分析

目的:探讨宫颈小细胞神经内分泌癌(small cell neuroendocrine carcinoma of the cervix,SCNCC)的临床病理和免疫表型。方法:复习4例SCNCC的临床病理资料,并将其组织学特征、免疫表型和预后与宫颈鳞癌进行比较。结果:SCNCC的发病年龄平均38.5岁,多表现为接触性出血或阴道不规则流血、排液。组织学特征为肿瘤细胞小而圆,胞质少,核染色质深染,核仁不明显,分裂象多见,可见坏死,肿瘤细胞呈片状浸润。免疫表型显示4例均表达至少一种神经内分泌标志。4例SCNCC的发病年龄低于宫颈鳞癌,淋巴结转移率高于宫颈鳞癌,近期随访结果显示预后较宫颈鳞癌差。结论:宫颈小细胞神经内分泌癌是一种少见的高度恶性肿瘤,具有独特的病理形态特征,预后较差。免疫组化染色有助于确诊。     

Small Cell Lung Carcinoma with Ectopic Adrenocorticotropic Hormone and Antidiuretic Hormone Syndromes: A Case Report

This report describes a 63-yr-old man with lung cancer accompanyinghypertension, hyperpigmentation, muscle weakness, psychosis,hypokalemia, hyperglycemia, hyponatremia, massive naturesisand lower serum osmolality than urine osmolality. Elevated levelsof plasma and urine corticosteroids and of plasma immunoreactiveadrenocorticotropic hormone (ACTH) were not altered by the administrationof large amounts of dexamethasone. Elevated plasma antidiuretichormone (ADH) values were also demonstrated. Postmortem examinationsrevealed small cell lung carcinoma with extensive metastasis,bilateral adrenocortical hyperplasia and Crooke's degenerationof the pituitary gland. Immunoradiological and immunohistochemicalstudies demonstrated the presence of immunoreactive ACTH, ADHand gastrin-releasing peptide in the tumor tissue. Beta-melanocyte-stimulatinghormone, calcitonin and carcinoembryonic antigen were also detectedby one of the methods. Hence, this is a rare case of lung cancerwith multiple hormone production and clinical and laboratoryevidence of both the ectopic ACTH and ADH syndromes. ^* Present address: Department of Internal Medicine, Keio UniversitySchool of Medicine, Tokyo, Japan     

Long-Term Management of a Patient with Well-Differentiated Pulmonary Neuroendocrine Carcinoma: A Case Report

Pulmonary neuroendocrine tumors (NET) are rare, and very few published reports have described the long-term treatment of patients with this disease. Current treatment options for patients with metastatic well-differentiated pulmonary NET are limited. This case report details the long-term treatment of a 62-year-old female patient with well-differentiated pulmonary NET and multiple liver metastases. The heavily pretreated patient achieved radiographic stability in measurable disease, improvement in nonmeasurable disease, and symptomatic improvement over 3 years while receiving the combination of everolimus and octreotide long-acting repeatable (LAR). Treatment was well tolerated without mucositis, rash, or pneumonitis. This case report suggests that the combination of everolimus and octreotide LAR may be a novel treatment option for heavily pretreated patients with metastatic well-differentiated pulmonary NET, but these findings require further analysis in clinical trials.Key words: Neuroendocrine tumors, Well-differentiated pulmonary neuroendocrine tumors, Pulmonary neuroendocrine tumors, Everolimus, Octreotide long-acting repeatable     

Renal Cell Carcinoma metastasizing to Larynx: A Case Report

Renal Cell Carcinoma (RCC) is a malignant tumor occurring in 5th-6th decade of life with an increasing incidence reported in the US but stable in Europe. The metastasis of RCC to head and neck region is infrequent and very rarely seen in larynx. Very few cases of RCC metastasizing to larynx are reported in literature. We report a case of RCC in a middle aged male with metastasis to larynx, 7 years after initial diagnosis and nephrectomy. These unusual tumor metastases have unique pathobiology and route of metastasis, and there can be a long interval from initial diagnosis of primary tumor. The diagnosis of metastatic RCC in unusual locations is often not easy. Treatment options include metastasectomy, radiotherapy and systemic chemotherapy but with a poor outcome. A differential diagnosis should always be considered in metastatic head and neck tumors. The need for prompt accurate diagnosis, risk stratification at initial primary diagnosis, surveillance, and long term regular follow up is emphasized. Key words: Metastatic RCC, Laryngeal metastasis, Royal Hospital Oman, Metastatic Ca, metachronous metastasis.     

原发性食管小细胞神经内分泌癌临床病理分析

目的分析原发性食管小细胞神经内分泌癌(ESCNC)的临床病理学特征在临床诊断中的价值。方法回顾性分析41例行食管根治手术的ESCNC患者的临床病理学特征。结果 ESCNC的发病率占同期原发性食管恶性肿瘤的0.80%。41例患者中淋巴结转移26例(63.41%)。CgA、Syn、NSE、CK阳性表达率分别为58.54%、58.54%、82.93%、90.24%,LCA均阴性表达。结论 ESCNC分化差、恶性程度高、进展迅速,CgA、Syn、NSE、CK在其诊断中有一定的意义。     

High-Dose Lanreotide in the Treatment of Poorly Differentiated Pancreatic Neuroendocrine Carcinoma: A Case Report

Pancreatic neuroendocrine tumors (NETs), including poorly differentiated carcinomas (NECs), are rarely encountered. The majority of these tumors do not secrete excess hormones, but functioning NETs produce large amounts of vasoactive peptides and may cause carcinoid syndrome. Synthetic somatostatin analogs (SSAs) have been widely used in NETs for control of hormonal syndromes. Here, we present a case of poorly differentiated, grade 3 pancreatic NEC associated with carcinoid syndrome, for which adequate symptom control was achieved for 2 years and 4 months using the long-acting SSA lanreotide Autogel^®. In February 2009, a 55-year-old woman presented with episodes of flushing, diarrhea and epigastric pain. Imaging techniques revealed the presence of a metabolically active mass expressing somatostatin receptors in the hilar area of the liver. Histopathological examination confirmed the malignant nature of the mass, which was identified as a poorly differentiated grade 3 pancreatic NEC (TNM staging: T4NxM0). Therapeutic options were limited for the patient because of the extent of the primary mass involving the celiac axis, severe gastrointestinal toxicity experienced as a side effect of chemotherapy with cisplatin-etoposide and, later in the course of the disease, extensive liver metastases and carcinoid heart syndrome. Along with a palliative debulking surgery and right portal vein embolization, biotherapy with a high dose of lanreotide Autogel (120 mg/14 days) contributed to alleviation of symptoms caused by hormone overproduction, even after the development of liver metastases. These results suggest that patients with poorly differentiated NECs who exhibit signs of carcinoid syndrome can benefit from treatment with somatostatin analogs.Key words: Neuroendocrine tumor, Pancreas, High-dose lanreotide, Carcinoid