上消化道转移癌的内镜表现和临床病理分析（附10例报告）*

Endoscopy and clinicopathological characteristics of upper gastrointestinal tract metastasis*

摘要:

了解上消化道转移癌的内镜表现和病理特征，提高内镜和病理医师对其的认识和诊断水平。方法 对本院收治的3例以消化道表现为首诊症状的上消化道转移癌患者以及复习相关文献中的7例患者的内镜表现和临床病理特征进行观察。结果 3例患者均以消化道出血、腹部不适等消化道表现为首诊症状而就诊。病例1内镜检查发现食管溃疡性病变，病理诊断为转移癌，考虑肺来源，后经影像检查证实；病例2内镜显示胃体隆起占位，病理诊断为鳞状细胞癌，建议临床进一步检查除外转移性，随后经影像学检查和气管镜活检证实为肺癌转移；病例3内镜检查发现胃和十二指肠多发息肉样病变，病理诊断为转移性肾细胞癌。3例患者均得到正确诊断，从而避免了不必要的根治性手术治疗。相关文献中的7例患者多为老年人，也均以各种消化道不适症状而首诊，既往无肿瘤病史，内镜检查病变位于胃或十二指肠，病理诊断过程中辅以免疫组化染色均诊断为转移癌，肿瘤原发部位无器官特异性。结论 上消化到转移癌非常少见，特别是以胃肠道表现为首发症状的病例极易误诊为原发癌，从而导致错误的治疗，其确诊依赖于内镜和病理检查,并辅以相应的影像学检查。

Abstract:

Abstract: Objective To explore the endoscopic and clinicopathological characteristics of upper gastrointestinal tract metastasis,it can improve the diagnosibility of endoscopists and pathologists. Methods Three cases of upper gastrointestinal tract metastasis and seven cases in the related literature were studied, and its endoscopy and clinicopathological findings were analyzed with a review of the literature, whose gastrointestinal symptoms were the first manifestation. Results Case 1 endoscopic detection of esophageal ulcer lesions, pathological diagnosis of metastatic cancer, considering the source of the lung, confirmed by imaging examination; Case 2 showed that the gastric body was prominent, and the pathological diagnosis was squamous cell carcinoma. It was suggested that the clinical examination should be carried out without metastasis, and then confirmed by imaging examination and bronchoscopy biopsy; Case 3 endoscopic examination revealed multiple polypoid lesions in the stomach and duodenum, and was pathologically diagnosed as metastatic renal cell carcinoma. 3 patients were correctly diagnosed, thus avoiding unnecessary radical surgical treatment. 7 cases of patients in the literature were aged, they were also in a variety of gastrointestinal symptoms and the first diagnosis, no previous history of cancer, endoscopic lesions in the stomach or duodenum, supplemented by immunohistochemical staining in pathological diagnosis were diagnosed as metastases, the primary tumor site without organ specific. Conclusion The metastasis of upper gastrointestinal tract is rare, especially when the gastrointestinal symptoms were the first manifestation,it is usually missed and misdiagnosed. The diagnosis relies on the endoscopic and pathological examination, supplemented by the imaging examination, so the patients could get effective treatment in time.