以皮肤多发转移灶为首发表现的肺小细胞癌:1例罕见病例报道

doi:10.3969/j.issn.1004-583X.2025.01.010

临床荟萃 ›› 2025, Vol. 40 ›› Issue (1): 65-69.doi: 10.3969/j.issn.1004-583X.2025.01.010

以皮肤多发转移灶为首发表现的肺小细胞癌:1例罕见病例报道

陈哲宇¹, 何倩倩², 郭小冬², 王环环³, 杨艳丽¹^,³(), 阿赛古丽¹

1.西北民族大学,甘肃兰州 730000
2.甘肃中医药大学,甘肃兰州 730000
3.中国人民解放军联勤保障部队第九四〇医院病理科,甘肃兰州 730000

收稿日期:2024-08-21 出版日期:2025-01-20 发布日期:2025-01-17
通讯作者: 杨艳丽,Email:a06974723@163.com
基金资助:
甘肃省科技计划资助(省青年科技基金)——GSDME对抗PD-L1或抗PD-1免疫治疗促进机制的研究(22JR5RA022);中国人民解放军联勤保障部队第940医院院内课题——GZMB通过Casp3/GsdmE信号通路诱导肝癌细胞线粒体焦亡的分子机制研究(2021yxky049)

Small cell lung carcinoma with multiple cutaneous metastases as the initial presentation: A rare case report

Chen Zheyu¹, He Qianqian², Guo Xiaodong², Wang Huanhuan³, Yang Yanli¹^,³(), A Saiguli¹

1. Northwest Minzu University,Lanzhou 730000,China
2. Gansu University of Chinese Medicine, Lanzhou 730000,China
3. Department of Pathology,The 940 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Lanzhou 730000,China

Received:2024-08-21 Online:2025-01-20 Published:2025-01-17
Contact: Yang Yanli,Email: a06974723@163.com

摘要/Abstract

摘要：

目的探讨以皮肤多发转移灶为首发表现的肺小细胞癌的临床意义及病理表现。方法回顾性分析1例以皮肤多发转移灶为首发表现的肺小细胞癌综合征临床资料, 并复习相关文献。结果患者男,65岁,无吸烟史,因“胸部、背部、腰部皮肤肿物生长、增大3个月”入院。最大直径6~12 cm球形肿物,肿物表面皮肤青紫、糜烂,触之质韧,与周围组织分界清晰。此外,患者自发病来食欲欠佳,既往“气管炎”40年。对右肩胛区皮下肿物进行组织活检。组织病理学确定了肿物的转移性质,符合肺小细胞癌皮肤转移。胸部X线和磁共振平扫显示右肺门部可见一巨大不规则肿块影,双侧肾周间隙、腹腔及右侧肩胛部、腰部、臀部等部皮肤多发转移。结论以皮肤转移灶为内脏原发性肿瘤首发症状的现象是极其罕见的,这可能是内部恶性肿瘤的第一个迹象。肿瘤转移到皮肤通常是预示预后不良的晚期事件。

关键词: 小细胞肺癌, 皮肤转移, 临床病理

Abstract:

Objective To investigate the clinical significance and pathological manifestations of small cell lung carcinoma with multiple skin metastases as the first manifestation. Methods The clinical data of a case of small cell lung carcinoma with multiple skin metastases as the initial manifestation were analyzed retrospectively, and the related literatures were reviewed. Results A 65-year-old male patient without smoking history was admitted due to “growth and enlargement of skin masses on chest, back and waist for 3 months”. With a maximum diameter of 6-12 cm, spherical masses on the surface of the skin were bluish and erosive, tough, and presenting a clear boundary with the surrounding tissue. In addition, the patient had poor appetite since the onset, with a 40-year history of tracheitis. Biopsy of the subcutaneous mass in the right scapular region was performed. Histopathology determined the metastatic nature of the mass consistent with cutaneous metastasis of small cell lung carcinoma. Chest X-ray and magnetic resonance plain scan revealed a large irregular mass in the right hilum of the lung, multiple skin metastases in the bilateral perirenal space, the abdominal cavity and the right scapula, waist and buttocks. Conclusion This rare case shows skin metastases as the first manifestation of primary visceral tumors, which may be the first sign of internal malignancy. Metastasis to the skin is usually a late event that predicts a poor prognosis.

Key words: small cell lung carcinoma, skin metastasis, clinicopathology

中图分类号:

R734.1

陈哲宇, 何倩倩, 郭小冬, 王环环, 杨艳丽, 阿赛古丽. 以皮肤多发转移灶为首发表现的肺小细胞癌:1例罕见病例报道[J]. 临床荟萃, 2025, 40(1): 65-69.

Chen Zheyu, He Qianqian, Guo Xiaodong, Wang Huanhuan, Yang Yanli, A Saiguli. Small cell lung carcinoma with multiple cutaneous metastases as the initial presentation: A rare case report[J]. Clinical Focus, 2025, 40(1): 65-69.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2025.01.010

https://huicui.hebmu.edu.cn/CN/Y2025/V40/I1/65

图/表 3

图1 组织学结果 a.低倍视野(40×)显示真皮中大量肿瘤细胞;b.中倍视野(100×)显示真皮全层以及皮下组织内密集肿瘤样细胞浸润,呈弥漫片状浸润或巢状排列;c、d.高倍视野(200×、400×)显示此种肿瘤细胞大小形态基本一致,体积较小,呈圆形,胞浆少,核分裂像多见,可见菊形团结构

Fig. 1 Histological results a. Low magnification field of view (40×) showing a large number of tumor cells in the dermis; b. Medium magnification field of view (100×) shows dense tumor-like cell infiltration in the whole dermis and subcutaneous tissue, with diffuse lamellar infiltration or nested arrangement; c, d. The high-magnification field of view (200×, 400×) showed that the size and shape of these tumor cells were basically the same, with small size, round shape, less cytoplasm, more mitotic images, and chrysanthemum cluster structure

图2 免疫组织化学结果 a.Ki67>70%(×100);b.CD56(+)(×100);c.CD99(+)(×100);d.CKp(+)(×100);e.Syn(+)(×100);f.TTF-1(+)(×100)

Fig. 2 Immunohistochemical results a. Ki67>70%(×100); b. CD56(+)(×100); c.CD99(+)(×100); d.CKp(+)(×100);e. Syn(+)(×100);f.TTF-1(+)(×100)

图3 磁共振成像 a.右肺门、左侧胸壁皮下、双侧肾周间隙、右侧肩部多发混杂信号肿块,边界清楚;b. 显示双侧肾周间隙、腰部及髂部皮下多发弥散受限肿块,边界清楚

Fig.3 MRI a. Multiple subcutaneous masses with mixed signal were found in the right hilum, left chest wall, bilateral perirenal space and right shoulder, with clear boundary; b. Multiple subcutaneous mass with restricted diffusion were found in the bilateral perirenal space, waist and pars iliaca, with clear boundary

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以皮肤多发转移灶为首发表现的肺小细胞癌:1例罕见病例报道

Small cell lung carcinoma with multiple cutaneous metastases as the initial presentation: A rare case report

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