1例以皮肌炎为首诊的胃癌临床报道并文献复习

Gastric cancer presenting with dermatomyositis as the first diagnosis:a case report and review of the literature

目的分析以皮肌炎为首诊的胃癌患者临床特征和诊治方法。方法收集河北工程大学附属医院收治的1例皮肌炎为首诊的胃癌患者的一般资料、临床表现、诊疗过程、病理报告及预后,分析其特点及诊疗效果,并复习相关文献。结果综合患者病历资料,通过院内多学科协作诊疗(MDT),结合上消化道造影、上腹部CT、电子胃镜及病理咬检诊断贲门胃底腺癌。积极术前准备后行胃癌根治术。手术病理结果显示为低分化腺癌,侵及全层。术后第6天,患者皮肌炎皮肤表现明显改善,药物治疗抵抗现象消失,药物治疗效果明显。结论临床对于皮肌炎患者应加强病史询问,配合消化道电子纤维镜检查,同时发挥MDT团队作用,对合并胃肠道肿瘤的患者早诊断、早治疗,提高患者预后及生存率。

Objective To analyze the clinical features,diagnosis and the treatment method of gastric cancer presenting with dermatomyositis as the first diagnosis.Methods The general information,clinical manifestations,diagnosis and treatment process,pathological report and prognosis of a patient with gastric cancer presenting with dermatomyositis as the first diagnosis in the Affiliated Hospital of Hebei Engineering University were collected.The characteristics and diagnosis and treatment effects of this case were analysed,and relevant literatures were reviewed.Results Through multi-disciplinary treatment(MDT)in the hospital,combined with upper gastrointestinal angiography,upper abdominal CT,electronic gastroscopy and pathological examination,the patient was diagnosed with gastric cardiac adenocarcinoma.The radical gastrectomy was taken after finishing preoperative preparation.Surgical pathology showed a poorly differentiated adenocarcinoma invading the whole layer.The skin manifestations of dermatomyositis and the resistance of drug therapy in this case were disappeared six days after surgery,and the drug treatment effect was obvious.Conclusion For patients with dermatomyositis,it is necessary to strengthen medical history inquiry,combine the digestive tract electronic fiberscope examination,and play the role of MDT team.It is important to improve the prognosis and survival rate of patients with gastrointestinal tumors by early diagnosis and treatment.