以皮肤表现首诊的胃癌一例并发皮肤转移癌临床分析

A case of gastric carcinoma with rash as initial symptoms and a clinical analysis of cutaneous metastatic carcinoma

目的统计我院皮肤科病理室皮肤转移癌患者资料,分析其临床特点,加深对皮肤转移癌的认识。方法报告1例以皮肤表现首诊的胃印戒细胞癌,并综合2011年1月—2016年1月的皮肤转移癌资料,分析患者年龄、性别、皮损形态特征和发生部位等特点,以及原发肿瘤的类型及皮肤转移癌与原发肿瘤发生时间的关系。结果共统计皮肤转移癌14例,占我科皮肤病理室组织病理切片总数0.24%(14/5 955例),其中男5例(36%),女9例(64%),平均年龄(57.46±12.02)岁;9例女患者中,原发于乳腺癌7例(77.8%),胃癌1例,未明确原发灶1例;5例男患者中,原发于肺癌3例(60.0%),食管癌1例,未明确原发灶1例。所有患者中以皮肤表现为首发症状3例,皮肤转移癌首发率21.4%(3/14);11例患者表现为浸润性红斑及红斑基础上的丘疹、结节,2例表现为头皮孤立结节,1例表现为胸腹部多发结节。14例皮损均分布于头颈部及胸腹部。3例患者的免疫组化显示为低分化腺癌,其中1例经及时化疗后皮损基本消失,随访1年已临床痊愈。结论皮肤转移癌发生率低,以皮肤表现首诊的转移癌少见。对于皮肤转移癌早发现、早诊断、早治疗可一定程度改善预后。

Objective To review the cases of cutaneous metastatic carcinoma in our dermatopathological department and analyze the clinical characteristics of the cases, so as to deepen the understanding of cutaneous metastatic carcinoma. Methods One case was reported and other 13 cutaneous metastatic carcinoma cases from Jan 2011 to Jan 2016 were retrospectively reviewed. The clinical features of all these 14 cases were analyzed. Results Total 14 patients were collected, accounting for 0.24% of the total. Of the total 14 patients, 5 cases（36%） were male and 9 cases（64%） were female. The average age was 57.46±12.02 years. For the 9 female cutaneous metastases patients, 7cases were originally from breast, one case from gastric carcinoma, and one with unknown origin; for the 5 male cutaneous metastases patients, 3 cases were originally from lung, one case from esophageal carcinoma, and one with unknown origin. Three cases of the 14 patients were diagnosed before primary tumor emerged, the incidence of skin metastasis before primary tumor detected was 21.4%. Infi ltrative erythema and nodules were observed in 11 patients, and solitary nodules were observed in the others 3 cases. Skin rash were all found in head, neck and ventrum. Poorly differentiated adenocarcinoma was determined by immunohistochemical method in 3 patients, and skin rashes vanished after chemotherapy in 1 patient. Other organs metastasis symptoms were not found in all the patients. Conclusion The incidence of cutaneous metastasis carcinoma is low. Metastatic carcinoma with skin lesions as primary presentation is rare. Early detection, diagnosis and treatment of cutaneous metastases are important to improve prognosis.