表现为头皮溃疡的肺癌头皮转移误诊分析并文献复习

Skin Metastasis from Lung Cancer with Ulcer and the Literature Review

目的讨论肺癌头皮转移的临床特点和诊治方法。方法回顾性分析1例肺癌头皮转移误诊病例资料,并复习相关文献。结果本例69岁女性,因头皮溃疡在当地医院皮肤科诊治,考虑头皮痈,给予局部抗感染治疗,无明显好转。1周前出现痰中带血,行胸部CT检查示左肺占位性病变,转我院。支气管镜检查示左肺上叶支气管黏膜异常,镜检活组织病理检查及两处头皮破溃组织病理检查均提示低分化鳞状细胞癌。临床诊断:左肺上叶低分化鳞状细胞癌(CT4N3M1,Ⅳ期)并头皮转移。确诊后患者拒绝治疗出院。结论以头皮溃疡为主要表现的头皮转移癌易导致误漏诊。对于中老年头皮潜行性溃疡常规治疗效果不佳者应考虑皮肤原发恶性肿瘤或其他组织器官恶性肿瘤转移可能,行影像学和病理学检查有助于明确诊断。

Objective To discuss characteristics,diagnosis and treatment of skin metastasis from lung cancer.Methods The clinical data of a case of scalp metastasis from lung cancer diagnosed in our department,were discussed and relevant literature was reviewed. Results The 69-year-old female was admitted to the dermatological department of a local hospital for scalp ulcer. Scalp carbuncle was considered and anti-infection treatment was given with,no obvious improvement.A week ago,blood appeared in phlegm,then left lung placeholder was found in chest CT and the patient was transferee to our hospital,and bronchoscope showed abnormal left upper lobe bronchus mucosa ulcer edge and scalp ulcer tissue pathological examination indicated poorly differentiated squamous cell carcinoma,as well as a clinical diagnosis of the left upper lobe as poorly differentiated squamous cell carcinoma（ CT4N3M1,stage Ⅳ） with scalp transfer. The patient gave up treatment.Conclusion Scalp ulcer as the first sign of scalp metastasis small-cell lung cancer is easy to be misdiagnosed and missed diagnosis. In case that conventional treatment for scalp stealth ulcer in middle-aged and old patients is not effective,the primary malignant tumor or metastasis from other tissues and organs of malignant tumor should be considered. Imaging and pathological examinations are helpful in diagnosis.