Yamamoto Junko, Yamano Shigeru, Nakatani Kimihiko, Akai Yasuhiro, Shiiki Hideo, Hashimoto Toshio
First Department of Internal Medicine, Nara Medical University.
Nihon Ronen Igakkai Zasshi. 2002 Sep;39(5):554-7. doi: 10.3143/geriatrics.39.554.
A 74-year-old man was admitted because of appetite loss in November 1999. A gastric ulcer was diagnosed, and a H2 blocker was given. He had had appetite loss since July 1997 and had experienced epigastric discomfort since October of 1997. On admission, hepatic and pancreatic lymph node swelling was detected by ultrasonography of the abdomen. Physical examination revealed a palpable mass in the middle region of the upper abdomen as well as gynecomastia. Laboratory findings showed high serum levels of hCG (11,700 mIU/ml) and high urinary levels of hCG (1,600 mIU/ml). Upper gastrointestinal endoscopy showed a gastric cancer of Borrmann type 3 in the posterior wall of the middle body. A biopsy revealed a moderately differentiated adenocarcinoma. hCG immunoreactivity was not seen in the cancer tissue. A contrast-enhanced CT scan of the abdomen revealed multiple lymph node swelling in the hepatic and pancreatic lymph nodes. There was a low-density area suggesting liver metastases. No other primary carcinomas were not detected. We believe that the gynecomastia was due to the hCG-producing tumor. The patient died 2 months after diagnosis.
一名74岁男性因食欲减退于1999年11月入院。诊断为胃溃疡，并给予H2受体阻滞剂治疗。他自1997年7月起出现食欲减退，自1997年10月起出现上腹部不适。入院时，腹部超声检查发现肝门和胰周淋巴结肿大。体格检查发现上腹部中部可触及肿块以及男性乳房发育。实验室检查结果显示血清hCG水平升高（11,700 mIU/ml），尿hCG水平升高（1,600 mIU/ml）。上消化道内镜检查显示胃体中部后壁有Borrmann 3型胃癌。活检显示为中分化腺癌。癌组织中未见hCG免疫反应性。腹部增强CT扫描显示肝门和胰周淋巴结多处肿大。有一个低密度区域提示肝转移。未检测到其他原发性癌。我们认为男性乳房发育是由产生hCG的肿瘤所致。患者在诊断后2个月死亡。
