- 期刊
Symptomatic Gastrointestinal Metastasis of Primary Lung Carcinoma-Report of Two Cases
原發性肺癌之症狀性胃腸道轉移－兩個病例報告
摘要
儘管肺癌早期就會擴散到全身各處，然而臨床上轉移到胃腸道的例子並不常見，而且通常只會發生在癌症末期病人身上。在英文文獻裡，過去五十年來大約只有五十幾個病例被發表過。肺癌合併胃腸道轉移以小腸最多，其中空腸發生率略多於迴腸，至於十二指腸、食道、冑、大腸與肛門則極為少見。常見冑腸轉移之表現有出血、腹痛、阻塞、破裂併發腹膜炎。細胞形態以鱗狀細胞癌總數最多，但以大細胞癌的胃腸道轉移傾向最高。對於肺癌合併有胃腸道轉移的病人而言，積極檢查與早期開刀是提供緩和治療的唯一方法，然而致病率及死亡率卻仍然居高不下且預後極差。在此我們提出一位以小腸破裂為最初表現之肺癌，及一位已知肺癌而以消化道出血來表現之胃轉移的病例，並回顧歷年來與此種病歷相關的文獻報告。
並列摘要
Despite the early and widespread dissemination of lung carcinoma to many body sites, clinically significant metastases isolated in the gastrointestinal tract are rare and typically occur only in the advanced stages of the disease. Only about 50 cases have been published in the past 5 decades in the English literature. The most common metastatic site is the small bowel, with the jejunum slightly higher than the ileum, and there are sporadic case reports of the duodenum, esophagus, stomach, large bowel, and anus. The common presentations of gastrointestinal metastasis are bleeding, abdominal pain, obstruction, and perforation with peritonitis. The most common cell type is squamous cell carcinoma, although gastrointestinal metastasis has a higher predilection for large cell carcinoma. Aggressive investigation and early surgery is the only method for providing palliation to these patients, but morbidity and mortality remain high and the prognosis is poor. Herein, we report 2 cases: a case of lung cancer with the initial presentation of small bowel perforation, and a case of known lung cancer with the presentation of gastrointestinal bleeding due to gastric metastasis; a literature review is also included.