以血便为首发症状的十二指肠腺癌误诊1例

1　病例介绍患者 ,男 ,6 1岁 ,因少量血便 ,腹痛 3天于 2 0 0 0年 12月 10日入院 ,行大肠镜、气钡灌肠、胃镜检查 ,均未发现异常 ,经止血、抑酸治疗 1周好转出院。 5个月后又出现血便、腹痛 2天于 2 0 0 1年 5月2 3日第 2次入院 ,便血量较第 1次增多 ,仍行上述检查及盆腔 CT未发现异常。血常规 :血红蛋白 98g/ L,白细胞8.7× 10 9/ L ,血小板 2 13× 10 9/ L ;骨髓象无异常 ,对症治疗 1周好转出院。逐渐出现消瘦、乏力、食欲不振及活动后心悸、胸闷等。 2 0 0 1年 8月 1日晨突发大量血便、伴头晕、心悸、恶心、出汗、口渴等急症入院。查体…     

小肠禁锢症误诊为卵巢肿瘤蒂扭转一例报告

1　病例报告患者女 ,32岁。因下腹疼痛 2天于 1995年 12月 2 0日入院。患者下腹疼痛呈持续性胀痛 ,以右下腹为甚 ,无放射痛 ,无恶心呕吐 ,无发冷发热。查体 :Ｔ 36 5°Ｃ ,Ｐ 80次 /分 ,Ｒ 16次 /分 ,Ｂｐ 14 /9ｋＰａ。心肺肝脾无异常 ,右下腹部压痛 ,无反跳痛。妇科检查 :外阴、阴道正常 ,宫颈光滑 ,无举痛 ,子宫前位 ,大小正常 ,活动可 ,子宫右上方压痛 ,未及明显包块。白细胞 7 5×10 9/Ｌ ,中性 0 73 ,血色素 118ｇ/Ｌ ,Ｂ超示子宫右前方 9 1ｃｍ×5 7ｃｍ无回声 ,内示 3 0ｃｍ× 2 6ｃｍ强回声 ,边界清晰。提示右侧卵巢肿瘤。入院…     

肺腺癌胸膜腔内广泛转移误诊胸膜间皮瘤1例报告

患男性，68岁．因胸闷、气促两月．不能平卧一周于94年3月29日入院，曾在外院行右侧胸穿．抽出血性胸水，细胞学检查见间变细胞．查体；消瘦、呼吸稍急促，气管轻度左偏．右胸第五肋以下叩诊实音、呼吸音消失，胸片报告：右侧胸腔大量积液。断层片示：右肺未见肿块，支气管无狭窄．     

放化疗治疗原发性十二指肠腺癌1例

本院于 1 996年收治 1例十二指肠腺癌 ,采用化放疗取得了肿瘤稳定控制 7个月 ,病人生存 1年。病例　女 ,40岁 ,主因上腹部不适 ,进食后加剧伴消瘦 1年 ,于 1 996年 1 1月 2 2日入院。查体 :消瘦 ,浅表淋巴结未及肿大 ,睑结膜轻度苍白 ,上腹中部可扪及鸡卵大圆形肿物 ,质中度硬 ,固定 ,表面光滑 ,随腹主动脉跳动 ,触之不适。Ｂ超示 :胰腺占位病变 ,5 .8× 4 .2ｃｍ ,包绕腹主动脉 ,饮水后 ,十二指肠通过缓慢。ＣＴ示 :胰头部占位病变 ,与腹主动脉紧密粘连 ,脾略厚。入院诊断 :胰腺癌。以 5 ＦＵ 50 0ｍｇ/ｄ 1 4ｄ ,ｉｖｇｔｔ,每次给药 2小…     

肺腺癌阑尾转移1例

患者男性 ,69岁。因咳嗽、咳痰并痰中带血 1周 ,于 2 0 0 0年 1 2月 1 6日入院。体检 :一般情况尚可 ,全身浅表淋巴结未扪及 ,心肺检查正常 ,腹平软 ,肝脾未触及 ,移动性浊音 (- ) ,CT示右上肺 3cm×3cm软组织块影 ,右肺门淋巴结肿大。行纤维支气管镜取活检 ,病理示右肺腺癌。经抗炎、止血治疗 ,患者咳嗽、咳痰及痰中带血症状减轻。入院 1周后无明显诱因出现脐周疼痛 ,后转至右下腹 ,呈剧烈钝痛 ,伴发热 ,体温 38.5～ 39.5℃ ,无恶心、呕吐、腹胀等。体检 :腹肌紧张 ,莫菲氏征 (- ) ,麦氏点压痛明显 ,无反跳痛 ,移动性浊音 (- ) ,血常规 :…     

胃肝样腺癌误诊为肝癌1例

1　病例报告患者,女性,42岁。1996年1月无明显诱因出现右上腹闷胀不适,无发热、黄疸及呕吐症状,服药效果不佳。入院前1周症状加重且出现腹痛并向右肩部放射,外院ＭＲＩ检查提示右肝外生性肿物,诊断为右肝癌,于1996年8月22日入我院拟行手术治疗。体检:一般情况尚可,全身皮肤、巩     

小肠恶性间质瘤误诊1例

患者男性,33岁,于2000年10月18日上午因反复出现黑便5年,加重伴乏力3天入我院消化科。患者自1995年起无明显诱因反复出现黑便,曾于1998年7月28日、1999年4月9日、2000年8月19日、2000年10月18日因黑便反复发作多次入院,行电子胃镜、电子肠镜、全消化道钡餐共6次检查均未见异常,两次 DSA肠系膜上动脉造影检查,其中第一次检查示：肠系膜上动脉出血（先天性血管畸形、炎症所致）并行栓塞术。术后停止解黑便,出院诊断为：小肠血管畸形。本次入院检查患者有明显乏力、冷汗、心悸,无腹痛、腹泻。当日下午行DSA肠系膜上动脉造影见回结…     

肺腺癌小肠与扁桃体转移一例报告

1病例报告 患者男,59岁,因“黑便”于2013—01-14入我院,2013-01无明显诱因出现柏油样便,全身乏力,精神差,伴心慌气短,吞咽困难,在当地医院治疗无效,遂就诊于我院。患者自发病以来,神志清,精神差,饮食睡眠良好,大便成柏油样,小便正常。既往体健。查体,KPS评分50,面色苍白,右侧扁桃体可见一约2cm×1．5cm×1．5cm大小基底较宽且带蒂肿块,表面附有坏死组织;心肺腹查体未见明显异常。     

调强放疗联合化疗治疗十二指肠腺癌1 例

患者,女,66岁,因"上腹不适2年、疼痛4个月"入院.肠镜见十二指肠降部环形溃疡,肠腔狭窄、僵硬,凸凹不平,黄苔覆盖.病理示:十二指肠降部腺癌.患者签字拒绝手术,同意放、化疗,予4周期DCF方案(多两紫杉醇75mg/m2,iv,d1+顺铂75mg/m2,iv,总量分d1,d2用+5-Fu 750mg/m2,jv,d1;q21d)化疗,化疗中出现1～2级胃肠道反应,1级手足综合征,1～2级骨髓抑制.     

年轻女性小肠肿瘤误诊1例

1　临床资料患者女 ,2 2岁 ,学生 ,因下腹胀痛 1周 ,发现盆腔包块 2天 ,于2 0 0 2年 11月 2 0日入院。妇科检查见 :外阴属未婚型 ,子宫正常大小 ,后穹窿饱满 ,于子宫前上方扪及一包块约 10cm× 10cm ,质中 ,活动 ,无压痛。B超示盆腔占位性病变 (10cm× 8cm ) ,腹水(7cm )。CT示盆腔占位性病变(6cm× 7cm× 9cm ) ,盆腔中等积液。临床诊断为卵巢肿瘤。于2 0 0 2年 11月 2 5持续硬膜外麻醉下行剖腹探查术 ,术中吸出血性腹水 30 0 0毫升 ,于距回盲部80cm处的小肠浆膜面 ,见有一14cm× 14cm× 9cm肿块 ,与大网膜粘连 ,其质脆 ,表面呈鱼肉样 ,…     

Resection of Small Bowel Adenocarcinoma Liver Metastasis Combined with Neoadjuvant and Adjuvant Chemotherapy Results in Extended Disease-Free Period—A Case Report

Small bowel adenocarcinoma (SBA) is a very rare tumor entity but occurs in up to 5% of patients suffering from familiar adenomatous polyposis (FAP). Because of nonspecific symptoms, diagnosis is usually made with delay, which contributes to high rates of metastatic disease at the time of diagnosis. The overall prognosis of SBA is poor with 5-year survival rates of 15–35%. For localized disease, complete surgical resection is the treatment of choice, whereas systemic chemotherapy is deemed indicated in tumors with metastatic spread. The optimal regimen has not been defined as yet. In October 2001, a 51-year-old woman with attenuated FAP, that had total proctocolectomy in 1994 was diagnosed with a jejunal adenocarcinoma. She subsequently underwent small bowel resection. Because a computed tomography (CT) scan in April 2002 revealed multiple liver metastases, chemotherapy with nine cycles FOLFOX6 was initiated. Afterwards, a small residual lesion in segment VIII was seen in CT scan but could not be identified by PET and at laparotomy in November 2002. In December 2003, again, a lesion was detected in S VIII. This solitary residual liver metastasis was resected in January 2004. Postoperatively, the patient received adjuvant chemotherapy with three cycles (with six applications in each cycle) 5-fluorouracil/folinic acid/irinotecan according to the AIO protocol. To date, more than 3 years after liver resection, the patient is still in complete remission and undergoes regular restaging investigations. Resection of liver metastases from SBA combined with neoadjuvant and adjuvant chemotherapy can result in extended disease-free survival and should undergo further investigation.     

肺腺癌心脏转移1例报道

肺癌是心脏恶性转移瘤中最常见的原发肿瘤，临床上心脏作为肿瘤的靶器官容易被忽略。我科最近收治1例肺腺癌心脏转移患者，报道如下。 1临床资料     

Clinical Outcomes of Small Bowel Adenocarcinoma

BackgroundSmall bowel adenocarcinomas (SBAs) are rare tumors. Management of SBA is extrapolated from colorectal cancer treatments. Recent evidence suggests that the biology and molecular features of SBA differ from colorectal cancer. The aim of this study was to evaluate the management and outcome of SBA patients.Patients and MethodsThe National Cancer Data Base (NCDB) was queried for patients with SBA between 2004 and 2013 using ICD-O-3 histology code 8140/3 and topography codes C17.0, C17.1, C17.2, C17.8, and C17.9. Univariate and multivariate survival analyses were conducted to analyze the association between SBA location and overall survival (OS) stratified by stage. Treatment outcomes of surgery, radiation, and systemic therapy were compared.ResultsA total of 7954 SBA patients were identified; duodenum (D) 4607 (57.9%), jejunum (J) 1241 (15.6%), ileum (I) 857 (10.8%), and unspecified 1249 (15.7%). A total of 53.6% patients were male, and 76.6% white. Median age was 66 years. D mostly presented as stage IV disease (37.6%), J as stage II (34.5%) and IV disease (33.8%), and I as stage II (32.2%) and III (30.3%) disease (P < .001). Grade distribution was similar among D, J, and I; the majority were moderately differentiated (40.8%-55.0%), followed by poorly differentiated (30.9%-35.8%) and well differentiated (6.0%-12.4%) (P < .001). D underwent surgery (50.2%) less often than J (90.8%) and I (94.5%) (P < .001). Adjuvant radiation was provided in 8.5% of D, 2.6% of J, and 2.1% of I (P < .001). Adjuvant chemotherapy was provided in 21.9% of D, 50.2% of J, and 42.0% of I (P < .001). The rate of adjuvant chemotherapy was the highest in patients with stage III SBA, and was as follows: D (43.4%), J (65.4%), and I (63.6%) (P < .001). In univariate and multivariate analyses of all patients, adjuvant chemotherapy was associated with improved OS in stage II-III SBA patients. J had the best 5-year OS rate (42.0%; 95% confidence interval, 38.8-45.1, P < .001), and D had the worst (23.0%; 95% confidence interval, 21.6-24.2, P < .001). In multivariate analysis stratified by stage, chemotherapy was associated with improved OS in patients with stage II-IV SBA.ConclusionMost SBA patients present with stage IV disease. D underwent surgery less often than J and I. Stage II and III D received adjuvant chemotherapy less often compared to stage II and III J and I. Adjuvant chemotherapy was associated with improved OS in patients with stage II-III disease. J had the best 5-year OS rate, and D had the worst.     

Chemotherapeutic Management of Small Bowel Adenocarcinoma Associated with Crohn's Disease

Abstract

Four patients with metastatic primary small bowel adenocarcinoma associated with Crohn's disease were successfully treated with low dose combination chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan with or without gemcitabine. Benefits included prolonged survival, objective responses, response of resistant tumors, downstaging, and a successful secondary complete resection (Ro) with a durable remission.     

Evaluation of Bevacizumab in Advanced Small Bowel Adenocarcinoma

Background

Small bowel adenocarcinomas (SBAs) are rarely seen tumors. Data regarding the use of chemotherapy together with bevacizumab in patients with advanced SBA are lacking. The aim of this study was the evaluation of treatment with bevacizumab in advanced SBA.

氟尿嘧啶类联合奥沙利铂方案治疗晚期转移性小肠癌的回顾性多中心研究

  目的  小肠癌是一种少见的消化道肿瘤, 多数患者初诊时已无法手术切除或出现远处转移, 因此化疗在小肠癌治疗中占有重要地位。本研究旨在评价FOLFOX和XELOX方案治疗晚期中国小肠癌患者的疗效及安全性。  方法  对2004年1月~2010年1月期间, 在中山大学肿瘤医院等3个中心所有接受过FOLFOX或XELOX方案化疗的34例晚期小肠癌患者进行了回顾性分析。利用SPSS13.0统计软件对方案的有效率(RR), 无进展生存时间(PFS), 总生存时间(OS)以及化疗相关的不良反应进行分析。  结果  共纳入病例34例, 其中28例接受了FOLFOX治疗, 6例接受了XELOX方案治疗。客观有效率及疾病控制率分别为32.3%和61.7%。中位PFS和OS分别为6.3和14.2个月。化疗相关不良反应可耐受, 3~4级不良反应发生率较少, 其中1~2级纳差(58.8%)、恶心(47.1%)、外周神经毒性(41.2%)是最常见的反应。  结论  本研究在国内首次报道了奥沙利铂联合氟尿嘧啶类方案治疗晚期小肠癌疗效, 结果显示FOLFOX或XELOX方案治疗晚期小肠癌安全有效, 该方案仍值得进一步研究。      

EGFR-Mutated Breast Metastasis of Lung Adenocarcinoma: A Case Report

Breast metastasis from other primary carcinoma is very rare and could be difficult to identify despite immunohistochemistry analysis. Breast metastasis from lung adenocarcinoma can mimic triple-negative breast cancer. Given the prognosis and therapeutic challenges, a correct diagnosis appears essential, and molecular biomarkers could be useful. We report the case of a 52-year-old woman with a breast mass initially diagnosed as primary breast cancer and secondarily attached to breast metastasis from an EGFR-mutated lung adenocarcinoma. The same activating EGFR mutations were identified in both the primary lung carcinoma and the breast metastasis.Key Words: Lung adenocarcinoma, Breast metastasis, EGFR mutation, Triple-negative breast cancer, EGFR tyrosine kinase inhibitors     

Intestinal Metastasis of a Primary Lung Carcinoma Presenting as Mechanical Small Bowel Obstruction

INTRODUCTION: Colorectal cancer is the third cause of death in industrialized countries. Genetic susceptibility and diet are determinant of cancer risk and tumor behavior. Variation in cancer incidence among and within populations with similar dietary patterns suggests that an individual response may reflect interactions with genetic factors, which may modify gene, protein, and metabolite expression patterns. Nutrigenomics, defined as the interaction between nutrition and an individual genome, will likely provide important clues about responders and non-responders to nutritional intervention. DISCUSSION: Epidemiological and experimental studies suggest a protective role of some normal components of daily diet (fish oil, milk, and vegetables), estrogens, and phytoestrogens in colorectal cancer. The effect of estrogen seems to be mediated by their binding to estrogen receptor beta (ER-β), one of the two estrogen receptors with high affinity for these hormones. Very recently, the demonstration of an involvement of ER-β in the development of adenomatous polyps of the colon has also been documented, suggesting the use of selective ER-β agonists in primary colorectal cancer prevention. Phytoestrogens are plant-derived compounds that structurally and functionally act as estrogen agonists in mammals. They are characterized by a higher binding affinity to ER-β as compared to estrogen receptor alpha (ER-α), the other estrogen receptor subtype. These biological characteristics explain why the administration of phytoestrogens does not produce the classical side effects associated to estrogen administration (cerebro- and cardiovascular accidents, higher incidence of endometrial and breast cancer) and makes these substances potential candidates for colorectal cancer prevention.     

Safety and Efficacy of Avelumab in Small Bowel Adenocarcinoma

IntroductionSmall bowel adenocarcinomas (SBAs) are rare and frequently treated like large intestinal adenocarcinomas. However, SBAs have a very different microenvironment and could respond differently to the same therapies. Our previous data suggested that SBAs might benefit from targeting the PD-1/PD-L1 axis based on PD-L1 staining in almost 50% of SBA tissue samples tested. Thus, we designed a phase 2 study to explore safety and efficacy of avelumab in SBA.Patients and MethodsPatients with advanced or metastatic disease were enrolled; ampullary tumors were considered part of the duodenum and allowed. Prior PD-1/PD-L1 inhibition was not allowed. Avelumab (10 mg/kg) was given every 2 weeks, and imaging was performed every 8 weeks. Primary endpoint was response rate.ResultsEight patients (n = 5, small intestine; n = 3, ampullary) were enrolled, with a majority (88%) being male and a median age of 61 years. Of 7 efficacy-evaluable patients, 2 (29%) experienced partial responses; stable disease occurred in 3 additional patients (71%). Median progression-free survival was 3.35 months. Most frequent, related toxicities were anemia, fatigue, and infusion-related reaction (25% each), mostly grade ≤2; grade 3 hypokalemia and hyponatremia occurred in one patient, and another reported grade 4 diabetic ketoacidosis.ConclusionsDespite the observed benefit, accrual was slower than expected and the study was closed early due to feasibility. A general clinic observation was that patients were receiving immunotherapy off-label as the availability of these agents increased. Off-label availability and disease rarity were likely drivers of insufficient accrual.