以单纯指骨转移为首发症状的肺癌2例并文献复习

Pure phalanx metastasis as the initial symptom in two cases of lung cancer and literature review

目的探讨原发性肺癌以单纯指骨转移为首发症状的临床特点以及肺癌发生指骨转移的机理。方法对1991年至2007年间，见诸于有关文献报道的以单纯指骨转移为首发症状的原发性肺癌病人的文献资料进行综合性分析。结果在文献报道的以单纯指骨转移为首发症状的17例原发性肺癌的病人中，其转移病灶位于左手指骨者7例，右手指骨者9例，双手指骨者1例，指骨转移病灶的数量在两手之间的分布大致相等，除3例病人其转移病灶位于近节指骨外，其余病人的转移病灶均位于其末节指骨；有6例病人的患病手指既往曾有外伤史。结论传统的机械一解剖学说和种子一土壤学说的观点均不能解释原发性肺癌发生指骨转移的机理，故临床上如遇久治不愈的手指软组织炎症时，应想到是否有肿瘤细胞转移至此的可能性。

Objective To study the clinical characteristics of primary bronchogenic carcinoma with metastases of phalanges of fingers as its first symptom and the mechanism of tumor metastasis to phalanges of fingers. Methods Literatures on primary bronchogenic carcinoma with metastases of phalanges of fingers as its first symptom published between 1991 and 2005 were reviewed, and were synthetically analyzed. Results 17 patients reported in the literature had primary bronchogenic carcinoma with metastases of phalanges of fingers as its first symptom. 7 patients＇ metastatic lesions located in their phalanges of left hands, 9 right hands and 1 both hands. The distribution of the quantity of the phalangeal metastases between two hands was almost equal. 3 patients＇ metastatic lesions were situated in proximal phalanges of fingers, and the rest in distal. 6 patients＇ ill fingers had had trauma history. Conclusions Neither the traditional machine anatomy theory nor seed-soil theory could explain the mechanism of primary bronchogenic carcinoma metastasizing to phalanges of fingers. If patients with soft tissue inflammation of fingers that cannot be healed for a long time are encountered, the possibility of tumor metastasis here should be considered.