Owers Ce, Stewart Dj, Stone J, Kelty Cj
Doncaster Royal Infirmary, Doncaster, UK.
J Surg Case Rep. 2010 Oct 1;2010(8):6. doi: 10.1093/jscr/2010.8.6.
A sixty-one year old man was referred with a history of progressive dysphagia, vomiting and weight loss with some back pain. Upper gastrointestinal endoscopy and biopsies revealed a gastro-oesophageal junction adenocarcinoma. Despite the absence of metastatic disease on computed tomography, positron emission tomography demonstrated multiple vertebral and sternal deposits. He was reviewed in an ENT clinic with a sudden onset of hearing loss accompanied by dizziness, but no focal neurology. Magnetic resonance imaging identified bilateral 2cm lesions at the internal auditory meatus, consistent with a diagnosis of bilateral acoustic neuromas. The patient subsequently died of carcinomatosis and, because of the potential familial significance of bilateral acoustic neuromas, a limited post-mortem examination was carried out. Unexpectedly, this revealed bilateral adenocarcinoma metastases infiltrating the internal auditory meatus affecting the acoustic nerves. The authors believe this a very rare presentation of metastatic gastric disease.
一名61岁男性因进行性吞咽困难、呕吐、体重减轻并伴有一些背痛前来就诊。上消化道内镜检查及活检显示为胃食管交界腺癌。尽管计算机断层扫描未发现转移性疾病，但正电子发射断层扫描显示有多处椎体和胸骨转移灶。他在耳鼻喉科门诊接受检查时突然出现听力丧失并伴有头晕，但无局灶性神经功能缺损。磁共振成像显示双侧内耳道有2厘米大小的病变，符合双侧听神经瘤的诊断。该患者随后死于癌病，由于双侧听神经瘤可能具有家族性意义，因此进行了有限的尸检。出乎意料的是，尸检发现双侧腺癌转移灶浸润内耳道，影响听神经。作者认为这是转移性胃病非常罕见的一种表现。
