Ahamed S H, Agarwal A K, Raju P P J
Department of Surgery, University Hospital of Hartlepool, Hartlepool, UK.
Ann R Coll Surg Engl. 2006 Oct;88(6):W4-5. doi: 10.1308/147870806X129278.
Prostate carcinoma presenting initially as supraclavicular lymphadenopathy has been increasingly reported as an uncommon presentation of the disease. The diagnosis is often made on lymph node biopsy as these patients rarely undergo digital rectal examination or serum prostate-specific antigen level measurement as part of their initial investigations. A 74-year-old man presented with supraclavicular lymphadenopathy and subsequently deteriorated with severe shortness of breath associated with venous congestion of the head and neck. The diagnosis of metastatic prostate adenocarcinoma was made only after cervical lymph node biopsy. Following the diagnosis, he was confirmed as having an abnormal prostate on digital rectal examination and a raised serum prostate-specific antigen level. The authors propose that a digital rectal examination and a serum prostate specific antigen level be included in the initial investigation process of male patients with persistent supraclavicular lymphadenopathy. This would prevent delay in diagnosis, allow early intervention and decrease patient morbidity.
前列腺癌最初表现为锁骨上淋巴结病的情况越来越多地被报道为该疾病的一种罕见表现。诊断通常通过淋巴结活检做出，因为这些患者很少在初始检查中接受直肠指检或血清前列腺特异性抗原水平检测。一名74岁男性因锁骨上淋巴结病就诊，随后病情恶化，出现严重气短并伴有头颈部静脉充血。仅在颈部淋巴结活检后才诊断为转移性前列腺腺癌。诊断后，直肠指检证实他前列腺异常，血清前列腺特异性抗原水平升高。作者建议，对于持续存在锁骨上淋巴结病的男性患者，应在初始检查过程中包括直肠指检和血清前列腺特异性抗原水平检测。这将防止诊断延误，允许早期干预并降低患者发病率。
