Three Metachronous Primary Malignancies: A Case Report and Literature Review

三重異時性多原發惡性腫瘤：病例報告與文獻回顧

方映棠(Ying-Tang Fang) ； 黃國棟(Kuo-Tung Huang) ； 王金洲(Chin-Chou Wang)

《胸腔醫學》 32卷3期 (2017/06) Pp. 142-149

摘要

A 63-year-old male who had been diagnosed as having esophageal squamous cell carcinoma (T1N0Mx post- endoscopic submucosal dissection) in 2011 presented with a left soft palate mass in 2012. Biopsy of the oral mucosa was performed and the pathology showed well-differentiated squamous cell carcinoma. This patient presented to Chang Gung Memorial Hospital in 2014 with blood-tinged sputum and progressive dyspnea. Initial chest x-ray showed right upper lobe consolidation. Chest CT examination revealed right upper lobe consolidation with a suspicious 6cm infiltrative mass invading the right hilum and mediastinum. Multiple liver nodules and masses in both lobes of the liver were also noted. Bronchoscopy examination with tissue biopsy for pathologic study revealed small cell carcinoma of the bronchus. Echo-guided fine needle aspiration for the right liver lobe tumor was performed and the pathology study showed small cell carcinoma, metastatic. The initial approach to patients with suspected lung cancer is based on the study results of patients with non-small cell lung cancer. In general a few things need to be considered, including selecting a biopsy site and obtaining an adequate sample for microscopic examination. Immunohistochemical and genetic analyses are necessary for confirmation of the diagnosis. Aggressive tissue biopsy for pathology study may increase the rate of diagnosis for double, or even triple primary malignancies. More precise diagnosis will provide more treatment choices.

關鍵字

metachronous primary malignancies ； esophageal squamous cell carcinoma ； small cell carcinoma

並列摘要

一位於西元2011 診斷為食道鱗狀上皮細胞癌的63 歲男性(T1N0Mx 經內視鏡黏膜下切除) 於西元2012 年因發現左軟顎腫塊前來就診，軟顎黏膜病理切片診斷為分化鱗狀上皮細胞癌。於西元2014 年病患以咳血及漸進性呼吸困難為表現，前來高雄長庚紀念醫院求診。胸部X 光片發現右上肺葉實質化，進一步的電腦斷層檢查發現右上肺葉腫塊合併多發性肝結節。本院為病患安排了支氣管鏡檢查合併腫瘤活檢切片，針對肝腫瘤則進行超音波導引細針穿刺術進行活檢切片，病理切片報告診斷為原發性肺小細胞癌合併肝轉移。針對疑似肺癌患者初始的評估診斷方法是基於先前非小細胞肺癌患者的研究結果。一般來說有幾件事情需要考慮，其中包括活檢部位的選擇，是否獲得足夠的鏡檢樣本。必要時免疫組織染色和遺傳分析是診斷確認的工具。針對病理切片檢查所採取的積極侵入性組織活檢可以提高雙重甚至三重原發惡性腫瘤的診斷率，更精確的診斷將提供更多的治療選擇。

並列關鍵字

異時性多原發惡性腫瘤 ； 食道鱗狀上皮細胞癌 ； 小細胞癌