Fujita Takeo, Ogasawara Yutaka, Naito Minoru, Doihara Hiroyoshi, Shimizu Nobuyoshi
Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
Surg Today. 2006;36(1):63-7. doi: 10.1007/s00595-005-3100-x.
A 75-year-old woman was hospitalized due to a right axillary mass. She had undergone a resection of thyroid carcinoma 13 years earlier, followed by two subsequent operations for recurrent thyroid disease. A physical examination revealed a right axillary mass associated with skin ulceration. Persistent bleeding was observed at the skin ulcer associated with the right axillary lymph node, despite conservative treatment for the lesion. Surgery was thus performed to control persistent bleeding from the axillary ulcer, and a histopathological examination resulted in a diagnosis of poorly differentiated thyroid carcinoma. The postoperative course was uneventful, but marked leukocytosis and extensive skin metastases were recognized 30 days postoperatively. A systemic examination revealed no other lesions associated with marked leukocytosis, but elevated levels of granulocyte colony-stimulating factor were noted in a blood examination. As a result, her general condition deteriorated rapidly and the patient died 2 weeks after the onset of leukocytosis.
一名75岁女性因右腋窝肿块入院。13年前她曾接受过甲状腺癌切除术，随后又因复发性甲状腺疾病进行了两次手术。体格检查发现右腋窝有一肿块，伴有皮肤溃疡。尽管对该病变进行了保守治疗，但右腋窝淋巴结相关的皮肤溃疡处仍有持续出血。因此进行了手术以控制腋窝溃疡的持续出血，组织病理学检查诊断为低分化甲状腺癌。术后过程顺利，但术后30天出现明显的白细胞增多和广泛的皮肤转移。全身检查未发现与明显白细胞增多相关的其他病变，但血液检查发现粒细胞集落刺激因子水平升高。结果，她的一般状况迅速恶化，白细胞增多症发作2周后患者死亡。
