Ghatei M A, Stratton M R, Allen J M, Joplin G F, Polak J M, Bloom S R
Department of Medicine, Hammersmith Hospital, Royal Postgraduate Medical School, London, UK.
Postgrad Med J. 1987 Feb;63(736):123-30. doi: 10.1136/pgmj.63.736.123.
A carcinoid tumour presenting as Cushing's syndrome is reported. Although no tumour mass could be initially identified the patient returned with first a liver and subsequently a cerebellar mass both of which were resected. Only at post-mortem was the lung primary discovered. ACTH, gastrin-releasing peptide (GRP) and calcitonin gene-related peptide were elevated in plasma before resection of the hepatic tumour. These peptides were demonstrated in both the hepatic and cerebellar tumours by immunocytochemistry and radioimmunoassay. This case illustrates the occasional tendency of primary lung carcinoids to remain small and clinically undetectable while generating secondary tumours which are symptomatic. It is suggested that immunological demonstration of GRP may be diagnostically helpful in directing attention to the lung as a primary site in neuroendocrine tumours which present in this fashion.
报告了一例表现为库欣综合征的类癌肿瘤。尽管最初未发现肿瘤肿块，但患者复诊时首先出现肝脏肿块，随后出现小脑肿块，二者均被切除。仅在尸检时才发现肺部原发肿瘤。在肝脏肿瘤切除前，血浆中的促肾上腺皮质激素（ACTH）、胃泌素释放肽（GRP）和降钙素基因相关肽升高。通过免疫细胞化学和放射免疫测定在肝脏和小脑肿瘤中均证实了这些肽。该病例说明了原发性肺类癌偶尔会在产生有症状的继发性肿瘤时仍保持较小且临床难以检测到的倾向。提示GRP的免疫学证实可能有助于诊断，将注意力引向以这种方式出现的神经内分泌肿瘤的肺部原发部位。
