CAJ | 학술논문

同时或者在6个月内发生的2种或2种以上原发性恶性肿瘤称为同时性多原发癌,发病率较低.2011年10月连云港市第一人民医院收治了1例食管基底细胞样鳞癌同时合并胃腺癌患者.该例患者以吞咽困难为主要症状,胃镜检查示食管、贲门至胃底多发包块,CT检查示食管中段隆起性包块,食管贲门至胃底管壁增厚,增强扫描见病灶轻度强化.左胸径路食管贲门癌切除术后病理检查示食管基底细胞样鳞癌,贲门中分化腺癌.食管基底细胞样鳞癌光镜下见粉刺样坏死和红染的基底膜样物,免疫组织化学检查示细胞角蛋白5/6、P63阳性,细胞角蛋白L弱阳性,突触素、嗜铬颗粒素A和CD117均为阴性.随访4个月,患者出现胸腔积液和多发肝转移,于2012年5月死于肝转移.食管基底细胞样鳞癌合并胃腺癌的多原发癌临床上较为罕见,诊断和鉴别诊断主要依靠组织学形态和免疫组织化学检查,治疗可选择手术切除联合术后放、化疗,但预后较差.
동시혹자재6개월내발생적2충혹2충이상원발성악성종류칭위동시성다원발암,발병솔교저.2011년10월련운항시제일인민의원수치료1례식관기저세포양린암동시합병위선암환자.해례환자이탄인곤난위주요증상,위경검사시식관、분문지위저다발포괴,CT검사시식관중단륭기성포괴,식관분문지위저관벽증후,증강소묘견병조경도강화.좌흉경로식관분문암절제술후병리검사시식관기저세포양린암,분문중분화선암.식관기저세포양린암광경하견분자양배사화홍염적기저막양물,면역조직화학검사시세포각단백5/6、P63양성,세포각단백L약양성,돌촉소、기락과립소A화CD117균위음성.수방4개월,환자출현흉강적액화다발간전이,우2012년5월사우간전이.식관기저세포양린암합병위선암적다원발암림상상교위한견,진단화감별진단주요의고조직학형태화면역조직화학검사,치료가선택수술절제연합술후방、화료,단예후교차.
Synchronous multiple primary carcinomas refers to 2 or more than 2 kinds of different primary malignant tumors develop synchronously or in 6 months.The incidence of synchronous multiple primary carcinoma is low.A patient with esophageal basaloid squamous cell carcinoma (BSCC) and gastric adenocarcinoma was admitted to the First People's Hospital of Lianyungang in October 2011.The main symptom of this patient was dysphagia,and multiple lesions were found in esophagus,cardia and stomach fundus by gastroscopy respectively.On computed tomography image,eminence lesion in esophageal midpiece and wall thickening from esophagus-cardia to stomach fundus were displayed and were both enhanced slightly by enhancement scanning.The esophageal and cardia tumors were resected via left thoracic approach,and postoperative pathological examination revealed esophageal BSCC and moderately differentiated adenocarcinoma of cardia respectively.Comedo necrosis and red basal membrane material were seen under light microscope.The expressions of cytokeratin 5/6 and P63 were positive,the expression of cytokeratin L was weak positive and the expressions of synaptophysin,chromogranin A and CD117 were negative.The patient suffered from pleural effusion and multiple liver metastases after 4 months follow-up and died of liver metastases in May 2012.Multiple primary carcinomas including esophageal BSCC and gastric adenocarcinoma are rarely seen in clinical practice.Their diagnosis and differential diagnosis mainly depend on histological morphology and immunohistochemical method.Surgical resection combined with postoperative radiotherapy and chemotherapy is selectable,but the prognosis is poor.