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[一例以副肿瘤综合征为表现的小细胞肺癌]

[A case of small cell lung cancer that presented with paraneoplastic syndrome].

作者信息

Wakatsuki Masatoshi, Matsuo Kiyoshi, Kayatani Hiroe, Fujiwara Keiichi, Yonei Toshiro, Sato Toshio

机构信息

Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center.

出版信息

Nihon Kokyuki Gakkai Zasshi. 2011 Jul;49(7):517-22.

Abstract

A 65-year-old man had suffered from systemic erythema from November 2008 and had noticed gradually progressing weakness in the upper and lower limbs. He received medical treatment in another hospital but his symptoms did not improve. He was admitted to our hospital for treatment of diabetes in June 2009, and his chest X-ray images and CT scans showed a mass shadow in the right upper lobe with hilar and mediastinal lymphadenopathy. We performed bronchoscopy, and diagnosed small cell lung cancer (T2N2M1, stage IV). However, he had hand grip weakness and continuing upper and lower limb muscle weakness, and therefore electromyography was performed, which showed the presence of waxing in the right leg. Subsequently, a diagnosis of Lambert-Eaton myasthenic syndrome was made. As he also showed ataxia of the left lower extremity, we also diagnosed paraneoplastic cerebellar degeneration. We gave the patient chemotherapy consisting of carboplatin and etoposide which resulted in the disappearance of his waxing, and his grip strength and erythema immediately improved with regression of the tumor after 1 course of chemotherapy. We report a case of small cell lung cancer associated with Lambert-Eaton myasthenic syndrome, paraneoplastic cerebellar degeneration and erythema which presented as paraneoplastic syndrome, which improved with chemotherapy.

摘要

一名65岁男性自2008年11月起出现全身性红斑,并逐渐注意到上肢和下肢无力逐渐加重。他在另一家医院接受了治疗,但症状并未改善。2009年6月因糖尿病入住我院治疗,胸部X线片和CT扫描显示右上叶有肿块阴影,伴有肺门和纵隔淋巴结肿大。我们进行了支气管镜检查,诊断为小细胞肺癌(T2N2M1,IV期)。然而,他存在握力减弱以及持续的上肢和下肢肌肉无力,因此进行了肌电图检查,结果显示右腿存在波动现象。随后,诊断为兰伯特-伊顿肌无力综合征。由于他还表现出左下肢共济失调,我们还诊断为副肿瘤性小脑变性。我们给予患者卡铂和依托泊苷组成的化疗方案,化疗1个疗程后,其波动现象消失,握力和红斑立即改善,肿瘤缩小。我们报告一例与兰伯特-伊顿肌无力综合征、副肿瘤性小脑变性和红斑相关的小细胞肺癌病例,这些表现为副肿瘤综合征,化疗后病情改善。

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