以神经副癌综合征为首发症状的肺癌临床误诊分析

The Misdiagnosis of lung cancer with paraneoplastic neurological syndrome as initial symptom

目的探讨以副肿瘤综合征的为首发症状的肺癌的误诊原因,以提高鉴别诊断的能力。方法回顾性分析以神经副癌综合征为首发症状的21例原发性肺癌病人的临床资料。结果在21例患者中,误诊为肌无力综合征8例,小脑梗死4例,脑干梗死2例,多发性周围神经炎3例,脊髓炎1例,肾上腺皮质功能亢进1例。最后均经病理和细胞学检查确诊为肺癌。首诊误诊率为100%(21/21)。结论 以神经系统副癌综合征为首发症状的肺癌,极宜被误诊,应拓宽诊断思路,及时进行临床全面检查和必要的辅助检查,寻找隐匿性肺癌病灶,以减少肺癌的误(漏)诊率。

Objective To explore the misdiagnosis of lung cancer with paraneoplastic neurological syndrome(PNS) as initial symptom to improve the ability of the differential diagnosis.Methods The clinical data of lung cancer patients with PNS as initial symptom were analyzed retrospectively.Results In the 21 patients,eight cases were misdiagnosed as myasthenia syndrome,four cases as cerebellar infarction,two cases as brainstem infarction,three cases as peripheral neuritis,one case as myelitis,the rest one as adrenocortical hyperfunction.All the cases were eventually diagnosed with lung cancer after all pathology and cytology.The misdiagnosis rate was 100%(21/21)at first visit.Conclusions Lung cancer with PNS as initial symptom can easily be misdiagnosed.The idea of diagnosis should be broadened and the occult lung cancer lesion is looking through a comprehensive clinical examination and necessary laboratory examinations,to reduce the misuse of lung cancer(missed) diagnosis rate.