空肠多发肉瘤样癌术后肺、脑转移:1例报告并文献复习

发布时间：2018-03-25 06:10

本文选题：肉瘤样癌　切入点：空肠　出处：《南方医科大学学报》2017年12期

【摘要】：目的探讨空肠肉瘤样癌患者的临床表现、治疗及预后等特点,为临床诊治提供参考。方法本文报道1例我院收治的空肠多发肉瘤样癌术后肺、脑转移患者,并分析14篇个案报道、共18例病例。结果患者因肠套叠并消化道出血,行空肠部分切除术,术后4月出现脑、肺等多发转移,术后8月因多器官功能衰竭而死亡。空肠肉瘤样癌国内外命名不统一,诊断困难,尤其难以早期明确诊断,主要诊断依据为病理检查和免疫组化。目前无明确的治疗指南,包括肿瘤在内的广泛手术切除是主要有效治疗手段,但预后极差,中位生存期仅为5.5月(0.36~36月),多死于复发和转移。结论空肠肉瘤样癌较罕见,本例空肠多发性发病并发脑等部位转移更加罕见。规范命名、尽早诊断、通过全身多部位扫描明确其他部位是否存在癌灶、充分评估病程以及尽早治疗均十分重要。手术是治疗的基础,可尝试运用各种肿瘤局部治疗手段。Ki-67作为预后判断和PD-L1靶向免疫治疗的潜在价值需进一步探究。
[Abstract]:Objective to investigate the clinical features, treatment and prognosis of patients with jejunal sarcomatoid carcinoma, and to provide reference for clinical diagnosis and treatment. Methods A case of lung and brain metastasis after operation of multiple sarcomatoid carcinoma of jejunum in our hospital was reported. Results partial jejunal resection was performed in 18 patients with intussusception and gastrointestinal bleeding. Multiple metastases such as brain and lung occurred 4 months after operation. Eight months after the operation, he died of multiple organ failure. The name of jejunal sarcoma-like carcinoma is not uniform at home and abroad, and it is difficult to diagnose, especially in the early stage. The diagnosis is mainly based on pathological examination and immunohistochemistry. At present, there is no clear treatment guideline. Extensive surgical resection, including tumor, is the main effective treatment, but the prognosis is very poor. The median survival time is only 5.5 months, 0.36 ~ 36 months, and most of them die from recurrence and metastasis. Conclusion: jejunal sarcoma-like carcinoma is rare. This case of multiple jejunum with brain metastasis is more rare. Standard name, early diagnosis, through the whole body multi-site scanning to determine whether there is cancer in other parts, It is very important to evaluate the course of disease and early treatment. Surgery is the basis of treatment. We can try to use various local tumor therapy methods. Ki-67 as a prognostic judgment and PD-L1 targeted immunotherapy of potential value need to be further explored.
【作者单位】：南方医科大学附属东莞市人民医院普外科;南方医科大学附属东莞市人民医院肿瘤内科;南方医科大学附属东莞市人民医院病理科;
【分类号】：R735.3

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