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腹腔镜胆囊切除术后不明胃肠道恶性肿瘤所致的迟发性切口部位转移

Delayed presentation of port-site metastasis from an unknown gastrointestinal malignancy following laparoscopic cholecystectomy.

作者信息

Rao Siddharth, Rathod Anil, Kamble Ashok, Gupta Dilip

出版信息

Singapore Med J. 2014 May;55(5):e73-6. doi: 10.11622/smedj.2013209.

Abstract

Port-site metastasis (PSM) is often encountered during laparoscopic surgery in patients with malignancy. We report a 45-year-old woman who presented with a single PSM from papillary adenocarcinoma after undergoing laparoscopic cholecystectomy for calculus cholecystitis. Post cholecystectomy, a diagnosis of chronic cholecystitis was confirmed on histopathology. The patient presented with a mass at the site of epigastric port 28 months after surgery. PSM was suspected on clinical examination, which was supported by findings on computed tomography and further confirmed by fine-needle aspiration cytology of the lump. The patient underwent surgical clearance of the mass, and histopathological examination proved the lesion to be papillary adenocarcinoma. The site of the primary tumour was not detected even after thorough examination. Based on the histopathology report following local surgical clearance, the patient was started on chemotherapy. This case is unusual because of the long delay prior to the presentation of PSM and the unknown primary malignancy.

摘要

恶性肿瘤患者在腹腔镜手术期间常出现穿刺孔转移(PSM)。我们报告一名45岁女性,因结石性胆囊炎接受腹腔镜胆囊切除术后,出现了来自乳头状腺癌的单发PSM。胆囊切除术后,组织病理学确诊为慢性胆囊炎。术后28个月,患者上腹部穿刺孔部位出现肿块。临床检查怀疑为PSM,计算机断层扫描结果支持这一怀疑,肿块细针穿刺细胞学检查进一步证实了该诊断。患者接受了肿块的手术切除,组织病理学检查证明病变为乳头状腺癌。即使经过全面检查,仍未发现原发肿瘤部位。根据局部手术切除后的组织病理学报告,患者开始接受化疗。该病例不同寻常,因为PSM出现前有很长的延迟,且原发恶性肿瘤不明。

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