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目的:报告1例胰尾粘液腺癌表现为孤立性脉络膜转移瘤。方法:一位57岁女患者主诉右眼中心视物变形。检眼镜检查见1个位于右眼黄斑中心、长约6PD的孤立性淡色隆起病灶。她没有特殊的既往眼科和全身病史。A/B超声检查证实在后极部黄斑内有一个实性病灶,荧光素血管造影发现中心病灶无渗漏区。结果:根据病史和临床发现,请求了FBC、血沉、LFT、胸部X线和腹部CT等检查。胸部X线发现在双肺野有多发性模糊的病灶,提示为转移性肺结节。CT发现肝内多发性结节和在胰尾的一个3.5cm×2.6cm病灶。进行了CT引导下的肝活检,证实为中度分化的转移性粘液腺癌。此后血液分析证实CA19-9升高。肿瘤原发部位证实为胰尾,并决定进行姑息治疗。结论:初发临床体征为孤立性脉络膜病灶经证实为胰尾癌的报告鲜见。这一病例提示,在发现未知来源实性脉络膜病灶的病例,进行详细的腹部影像学检查是重要的。
Objective: To report a case of pancreatic mucinous adenocarcinoma showing solitary choroidal metastasis. Methods: A 57-year-old female patient complained of distortion in the right eye center. Ophthalmoscopy see a right eye in the center of the macular, about 6PD lone pale bulging lesions. She does not have a special history of previous ophthalmology and general health. A / B ultrasound confirmed in the posterior pole macular have a solid lesion, fluorescein angiography found no leakage of central lesions. Results: According to medical history and clinical findings, FBC, ESR, LFT, chest X-ray and abdominal CT examination were requested. Chest X ray found in the lung field have multiple blurry lesions, suggesting that metastatic pulmonary nodules. CT found multiple intrahepatic nodules and a 3.5cm × 2.6cm lesion at the tail of the pancreas. Liver biopsy under CT guidance was confirmed as moderately differentiated metastatic mucinous adenocarcinoma. Blood analysis confirmed subsequent elevation of CA19-9. The primary tumor site was confirmed as pancreatic tail, and decided to palliative treatment. CONCLUSIONS: The first clinical signs of solitary choroidal lesions confirmed as pancreatic tail cancer are rare. This case suggests that a detailed abdominal imaging examination is important in the detection of solid choroidal lesions of unknown origin.