论文部分内容阅读
肝门部胆管癌曾被普遍认为生长缓慢。骨骼肌是恶性肿瘤转移最不常见的部位之一。我们报道1例肝门部胆管癌伴乳腺和骨骼肌同时转移,并做相关文献综述。一48岁女性病人,因黄疸并体重减轻入院,诊断为肝门部胆管癌Bismuth-Corlette Ⅳ,行 ERCP塑料内支架置入术加体外三维适型放疗,效果良好,2个月后肝门部肿瘤明显缩小,黄疸消退,正常生活。因经济原因拒绝手术。10个月后,发现左大腿痛性肿块和左乳无痛性包块,全身检查未发现其他部位转移灶,原发灶肿瘤无明显变化,诊断为肝门部胆管癌伴左乳腺及左股网头肌的股直肌转移,并经术后病理证实。但术后4个月起,患者再次出现黄疸,频发胆管炎,不能耐受放疗,最终死于肝功能衰竭。肝门部胆管癌并远处转移文献报道很少,病人多是局部病变广泛并全身多发转移,转移部位多是颈淋巴结、骨骼及门脉系统,但原发灶肿瘤稳定时伴乳腺和骨骼肌同时转移尚未见报道。
Hilar cholangiocarcinoma has generally been thought to grow slowly. Skeletal muscle is one of the most common sites of malignant tumor metastasis. We report a case of hilar cholangiocarcinoma with mammary gland and skeletal muscle at the same time, and make relevant literature review. A 48-year-old female patient admitted to hospital for jaundice and weight loss was diagnosed with bismuth-corlette IV hilar cholangiocarcinoma. ERCP plastic stent placement combined with 3-D external stereotactic radiotherapy performed well. After 2 months, Tumor was significantly reduced, jaundice subsided, normal life. Reject for surgery for economic reasons. 10 months after the discovery of pain in the left thigh pain and left lump painless mass, systemic examination found no metastases in other parts of the primary tumor no significant change in the diagnosis of hilar cholangiocarcinoma with left breast and left Rectus femoris rectus muscle transfer, and confirmed by postoperative pathology. However, 4 months after surgery, patients again appear jaundice, frequent cholangitis, can not tolerate radiotherapy, and ultimately died of liver failure. Hilar cholangiocarcinoma and distant metastasis rarely reported in the literature, the patient is mostly localized lesions and systemic multiple metastasis, metastasis site mostly cervical lymph nodes, bones and portal system, but the primary tumor with stable breast and skeletal muscle At the same time transfer has not been reported.