Yamaguchi Emi, Uchida Masaaki, Makino Yoshinari, Tachibana Maromi, Sato Takashi, Yamamoto Yoshio, Kawashima Kousaku, Araki Asuka, Maruyama Riruke
Clin J Gastroenterol. 2010 Dec;3(6):289-95. doi: 10.1007/s12328-010-0176-7. Epub 2010 Sep 17.
Metastasis from a malignant tumor to the palatine tonsils is rare, with only 100 cases reported in the English-language literature. Tonsillar metastasis from a gastric cancer is very rare. We report here a case of palatine tonsillar metastasis after gastric cancer surgery. The patient was an 88-year-old woman who had gastric cancer with abdominal wall invasion. She had undergone a distal gastrectomy with abdominal wall resection and D2 lymph node dissection. Histologically, the tumor was primarily a moderately differentiated adenocarcinoma. It was stage IV (T4, N1, M0) using TNM clinical classification. The patient developed pharyngeal discomfort and abdominal pain and was hospitalized during the follow-up period, 1 year 9 months post-operatively. Multiple lung metastases, Virchow's lymph node metastasis, and adrenal metastasis were observed. A mass of 2.5 cm was also observed in the right palatine tonsil. It was diagnosed as a moderately differentiated adenocarcinoma, a metastasis from gastric cancer. There was a concern of asphyxiation due to hemorrhage of the tumor; however, the tumor dislodged approximately 10 days after biopsy and tonsillar recurrence was not observed. The patient died 1 year 10 months post-operatively. In the literature there are cases with tonsillar metastases where surgical treatment, radiotherapy, and chemotherapy were performed and extension of survival was seen. Tonsillar metastasis is a form of systemic metastasis of a malignant tumor, and there is a high risk for asphyxiation from tumor dislodgement or hemorrhage. Thus, it is important to recognize tonsillar metastasis as an oncologic emergency.
恶性肿瘤转移至腭扁桃体罕见，英文文献中仅报道过100例。胃癌转移至扁桃体极为罕见。我们在此报告1例胃癌手术后发生腭扁桃体转移的病例。患者为一名88岁女性，患有侵犯腹壁的胃癌。她接受了远端胃切除术、腹壁切除术及D2淋巴结清扫术。组织学检查显示，肿瘤主要为中分化腺癌。根据TNM临床分类，其分期为IV期（T4，N1，M0）。术后1年9个月随访期间，患者出现咽部不适和腹痛并住院。观察到多发肺转移、魏尔啸淋巴结转移及肾上腺转移。右侧腭扁桃体还发现一个2.5 cm的肿物。诊断为中分化腺癌，系胃癌转移所致。因肿瘤出血存在窒息风险；然而，活检后约10天肿瘤自行脱落，未观察到扁桃体复发。患者术后1年10个月死亡。文献中有对扁桃体转移病例进行手术治疗、放疗及化疗并延长生存期的报道。扁桃体转移是恶性肿瘤全身转移的一种形式，因肿瘤脱落或出血导致窒息的风险很高。因此，将扁桃体转移识别为肿瘤急症很重要。
