小細胞肺癌合併急性胰臟炎

Small Cell Lung Cancer Combined with Acute Pancreatitis

吳鴻昌(Hung-Chang Wu) ； 蘇五洲(Wu-Chou Su)

《中華民國癌症醫學會雜誌》 24卷6期 (2008/12) Pp. 386-390

https://doi.org/10.6588/JCOS.2008.24.6.7

摘要

我們報告一位64歲男性在就醫前已有咳血症狀二個月。胸部電腦斷層顯示在右下肺葉有一個約4.0x1.5x1.2立方公分不規則形狀的腫瘤，合併肋膜增厚，縱膈腔淋巴結病變，腎上腺及骨轉移。經支氣管鏡切片的病理報告為小細胞肺癌。然而在住院當中出現上腹悶痛並輻射到後背的症狀，同時amylase和lipase值也異常升高。磁振共振造影發現僅有胰臟腫大，無膽道結石。診斷為急性胰臟炎。經支持性療法腹痛穩定後又再次復發。重新檢視過去影像學檢查發現在胰臟本體有一低訊號的結節，高度懷疑是轉移所引起急性胰臟炎。病人接受化學治療後，腹部悶痛的情形很快地好轉，且amylase和lipase值稍後也回到正常範圍。病患出院後持續在門診追蹤一年沒有再發生類似的情況。關於轉移引起急性胰臟炎，據過去的文獻報告大多為小細胞肺癌造成。這群病人的預後大部分不好，特別是Ranson's score高分的一群。針對Ranson's score較低分的這一群病人，早期給予化學治療有助快速緩解症狀，且可能有較長的存活期。因此在小細胞肺癌的病人如果有上腹悶痛且異常amylase和lipase值的表現，我們應該考慮轉移引起急性胰臟炎的可能性以期早期診斷，即時給予適合病患的化學治療，以求快速緩解及延長存活時間。

關鍵字

轉移引起急性胰臟炎 ； 小細胞肺癌

並列摘要

A 64-year-old man who developed persistent hemoptysis for 2 months. Chest CT scan with contrast enhancement showed an irregular lesion, about 4.0 x 1.5 x 1.2 cm in size over right lower lobe with pleural thickening, mediastinal lymphadenopathy, adrenal gland and bone metastasis. The pathology of bronchoscopic tissue biopsy showed small cell lung cancer. During hospitalization, he complained of epigastralgia with radiation to the back. The blood test showed elevated amylase and lipase levels. The magnetic resonance imaging (MRI) revealed swollen pancreas but no choledocholithiasis. Acute pancreatitis was diagnosed. Pancreatitis relapsed again after conservative treatment. After reviewing the previous imaging study, a low-density lesion in the pancreas was found. Metastasis induced acute pancreatitis (MIAP) was suspected. We gave him systemic chemotherapy with the regimen of etoposide and cisplatin. Abdominal pain subsided quickly and the serum level of amylase and lipase returned to normal range later. During the regular follow-up in the outpatient clinics, he did not experience the same episode again. In the literature, the majority of MIAP is caused by small cell lung cancer. Poor prognosis was noted, especially in patients with high Ranson's scores. In patients with small cell lung cancer who develop epigastralgia and elevated level of lipase and amylase, we should consider the possibility of MIAP. Early diagnosis helps us to identify patients with good performance for chemotherapy, which may lead to resolve pancreatitis and improve the survival for them.

並列關鍵字

metastasis-induced acute pancreatitis MIAP ； small cell lung cancer