胆囊小细胞癌伴肝脏和腹膜后淋巴结转移1例报告及文献复习

Small cell carcinoma of gallbladder with liver and retroperitoneal lymph node metastasis: A case report and literature review

目的:分析胆囊小细胞癌(SCC)患者的临床表现、影像学和病理学特征和治疗方法,提高临床医师对该疾病的认识。方法:收集1例胆囊SCC患者的临床资料,并结合相关文献复习,探讨胆囊SCC的临床特点、诊断和治疗方法。结果:患者,男性,51岁,因"上腹部胀痛伴腰背部放射痛半月余"入院。腹部CT提示胆囊占位。肝脏动脉和静脉血管成像CT检查,胆囊新生物侵犯胆总管,胆总管及肝内胆管扩张,肝脏多发转移,肝门区腹膜后淋巴结转移。肿瘤相关抗原CA125水平为65.2 U·mL^(-1),神经元特异性烯醇化酶(NSE)水平为23.5μg·L^(-1),两者均升高。行超声引导下肝脏占位性病变穿刺活检,病理诊断为转移性SCC。结合病史和临床资料诊断为胆囊SCC伴肝脏及腹膜后淋巴结转移。患者确诊后未行手术治疗,接受2个周期依托泊苷口服化疗,4个周期奈达铂+依托泊苷(EP)静脉化疗,复查腹部CT发现病灶明显缩小。目前患者病情稳定,密切随访中。结论:胆囊SCC临床表现特异性较差,且容易发生远处转移,病理诊断和免疫组织化学法是诊断本病的金标准,本例胆囊SCC患者EP方案治疗有效,肿瘤体积明显缩小。胆囊SCC患者治疗过程中应定期随访。

Objective:To analyze the clinical manifestations,imagical and pathological features and treatment methods of one patient with small cell carcinoma(SCC)of gallbladder,and to improve the clinicians’understanding of SCC.Methods:The clinical materials of one patient with gallbladder SCC were collected,and the clinical features,diagnosis and treatment methods of gallbladder SCC were discussed combined with the related literature review.Results:The male patient aged 51 years old was admitted to hospital because of"upper abdominal pain with radiating pain in the lower back for more than half a month".The abdominal CT results indicated the gallbladder mass.The liver artery and vein angiography CT examination results showed that the gallbladder neoplasm invaded the common bile duct with common bile duct and intrahepatic bile duct dilatation,multiple liver metastasis and retroperitoneal lymph node metastasis in hilar region.The tumor-associated antigen CA125 level was 65.2 U·mL^(-1) and neuron-specific enolase(NSE)level was 23.5μg·L^(-1),and both the levels were increased.The patient underwent ultrasound-guided puncture biopsy of liver space-occupying lesions and was pathologically diagnosed as metastatic SCC.Combined with the medical history and clinical data,gallbladder SCC with liver and retroperitoneal lymph node metastasis was diagnosed.After diagnosis,the patient received2 cycles of etoposide oral chemotherapy,4 cycles of nedaplatin+etoposide(EP)intravenous chemotherapy rather than the surgical treatment.The re-examination of abdominal CT results revealed that the lesion was significantly reduced.The patient was currently in stable condition and was under close follow-up.Conclusion:The clinical manifestations of gallbladder SCC are poorly specific and prone to distant metastasis.Pathological diagnosis and immunohistochemistry are the golden standards for the diagnosis of gallbladder SCC.In this case,the EP regimen of gallbladder SCC is effective and the tumor volume is significantly reduced.The patients with gallbladder SCC should be followed up regularly during the treatment process.