胃印戒细胞癌伴肺淋巴管癌病三例并文献复习

Pulmonary lymphangitic carcinomatosis from gastric signet ring cell carcinoma:three cases report and literature review

目的提高对胃印戒细胞癌伴肺淋巴管癌病(PLC)的临床表现、胸部影像学表现及病理特征的认识,减少误诊。方法对3例诊断为胃印戒细胞癌伴PLC患者的临床表现、影像学资料,结合有关文献进行回顾性分析。以"肺淋巴管癌病"、"肺癌性淋巴管炎"、"胃印戒细胞癌"及"pulmonary lymphangitic carcinomatosis"、"gastric signet ring cell carcinoma"为检索词在万方、维普、中国知网及Pubmed数据库检索相关文献并进行分析。结果 3例患者年龄20~50岁,平均年龄34岁,其中2例男性,1例女性,均因不同程度的咳嗽、气促等呼吸道症状就诊。胸部高分辨率CT表现:3例均可见不均匀小叶间隔增厚,1例伴有纵隔淋巴结肿大,2例合并双侧胸腔积液。3例均行胃镜活检病理示胃印戒细胞癌。其中1例经化疗已生存7个月,另2例失访。经文献检索共检索到2例胃印戒细胞癌伴PLC患者,2例均为女性,年龄分别为45岁和59岁,临床主要表现为干咳、活动后气促,生存期均不足1个月。结论胃印戒细胞癌伴PLC临床症状缺乏特异性,容易误诊为肺部原发疾病。本病预后差,早期诊断、早期治疗可延长生存期。

Objective To investigate the clinical, radiological and pathological features of pulmonary lymphangitic carcinomatosis （PLC） from gastric signet ring cell carcinoma. Methods The data of 3 cases of PLC from gastric signet ring cell carcinoma were analyzed and relevant literature was reviewed. The electronic databases of Wanfang, VIP, CNKI and PubMed were searched by using the keywords ＂pulmonary lymphangitic carcinomatosis＂ and ＂gastric signet ring cell carcinoma＂. Results The average age of three patients was 34 years （ranging from 20 to 50 years）. There were 2 males and 1 female. The three patients presented with non-specific respiratory complaints of cough and shortness of breath. Thickening of interlobular septa was the major radiographical abnormality. Mediastinal lymphadenopathy was seen in i patient. Bilateral pleural effusion was seen in 2 patients. However, gastroscopy revealed metastatic gastric signet ring cell carcinoma with the presence of lymphagitic carcinomatosis. One patient survived more than seven months with systemic chemotherapy began on day 7 of hospitalization based on the follow-up information available. Literature review found 2 cases of PLC from gastric signet ring cell carcinoma. Two cases were female aged 45 and 59 years. The chief complaints were dry cough and shortness of breath. The survival time was less than I month from diagnosis. Conclusions PLC from gastric signet ring cell carcinoma is easily misdiagnosed as primary pulmonary diseases. Early identification, diagnosis and treatment are crucial to improve the survival of PLC patients.