摘要
目的分析以肺淋巴管癌病(PLC)为首诊的胃癌患者的临床特点,增强对PLC的认识,降低误诊率。方法回顾性分析我科2006-2016年以PLC为首诊的胃癌患者,总结其临床资料、实验室和胸部CT表现。结果 15例患者纳入分析,男女性别比例为1:2.75;平均年龄42±13岁(20~67岁);大部分患者表现为不明原因的咳嗽、气短、进行性呼吸困难;13例患者行肿瘤标记物检查,其中100%的患者CA724升高(13/13),53.8%的患者CA199升高(7/13),53.8%的患者CA242升高(7/13);胸部高分辨CT表现以结节样小叶间隔增厚最常见(100%),其他病变包括支气管血管束增粗(66.67%),双侧胸腔积液(60%)和肺门或纵隔淋巴结肿大(86.67%);胃镜活检病理提示12例为低分化腺癌,3例为胃印戒细胞癌。结论胃癌伴PLC多发于中年女性,临床症状缺乏特异性,尤其缺乏消化道症状,胸部影像学具有一定特征性,原发胃癌病理多见于低分化腺癌,结合CA724等血清肿瘤标记物,有助于尽快明确诊断。
Objective To analyze the clinical characteristics of pulmonary lymphangitic carcinomatosis( PLC) as the first manifestation of gastric cancer,in order to enhance the awareness of PLC and reduce the misdiagnosis rate. Methods The clinical data and chest CT of patients with PLC as the first manifestation of gastric cancer from 2006 to 2016 were retrospectively analyzed. Results The ratio of male to female was 1: 2. 75,and the mean age was 20 ± 67 years old. Most patients had cough and shortness of breath. 13 patients were given tumor markers test. CA724 had high levels in 100% patients( 13/13),CA199 in 53. 8%( 7/13) and CA242 in 53. 8%( 7/13).CT radiographic manifestations included nodular thickening of interlobular septa in 100%,coarse bronchovascular bundle( 75%),hilar or mediastinal lymphadenopahty( 83. 3%) and pleural effusion( 66. 7%). In the 12 patients,the histologic type of GC was poorly differentiated adenocarcinoma and 3 of them had signet ring cell carcinoma. Conclusion Middle-aged female patients,especially those with poorly differentiated adenocarcinoma are more likely to have PLC from GC. Patients with PLC usually present with respiratory symptoms. Tumor markers and PET/CT are crucial to improve diagnosis rate.
出处
《临床肺科杂志》
2017年第9期1676-1678,共3页
Journal of Clinical Pulmonary Medicine
关键词
肺淋巴管癌病
胃癌
胃印戒细胞癌
pulmonary lymphangitic carcinomatosis
gastric cancer
gastric signet ring cell carcinoma
