van Klaveren R J, de Mulder P H, Boerbooms A M, van de Kaa C A, van Haelst U J, Wagener D J, Hafkenscheid J C
Department of Internal Medicine, Nijmegen University Hospital, The Netherlands.
Gut. 1990 Aug;31(8):953-5. doi: 10.1136/gut.31.8.953.
A 46 year old white man presented with subcutaneous and intramedullary fat necrosis, destructive polyarthritis, and osteolytic bone lesions, complicating a poorly differentiated adenocarcinoma of the tail of the pancreas with metastases in the liver and omentum. There was a 100-fold increase in serum lipase and trypsin activity. His condition deteriorated rapidly, was characterised by rapid tumour growth, formation of ascites, a 20 kg weight loss, extensive subcutaneous fat necrosis, and fistula formation in the left calf. Treatment with 5-fluorouracil 300 mg/m2 on days 1-5 and doxorubicin 50 mg/m2 and cisplatin 100 mg/m2 on day 1, every three weeks, was well tolerated and resulted in rapid clinical improvement. After three courses of treatment a partial remission was seen and after seven courses further improvement occurred with a return to normal of serum lipase and trypsin activity. One year after starting chemotherapy the tumour relapsed but responded again to chemotherapy (epirubicin 40 mg/m2 and carboplatin 300 mg/m2 on day 1, every three weeks).
一名46岁白人男性，患有皮下及骨髓脂肪坏死、破坏性多关节炎和溶骨性骨病变，这些症状使他胰腺尾部的低分化腺癌并伴有肝和大网膜转移的病情更加复杂。其血清脂肪酶和胰蛋白酶活性增加了100倍。他的病情迅速恶化，表现为肿瘤快速生长、腹水形成、体重减轻20千克、广泛的皮下脂肪坏死以及左小腿出现瘘管。每三周进行一次治疗，第1 - 5天给予5 - 氟尿嘧啶300 mg/m²，第1天给予阿霉素50 mg/m²和顺铂100 mg/m²，患者耐受性良好，临床症状迅速改善。三个疗程后出现部分缓解，七个疗程后进一步改善，血清脂肪酶和胰蛋白酶活性恢复正常。开始化疗一年后肿瘤复发，但再次化疗（第1天给予表柔比星40 mg/m²和卡铂300 mg/m²，每三周一次）仍有反应。
