Lee Charlotte, Thon Jesse M, Dhand Amar
Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
BMJ Case Rep. 2017 Nov 8;2017:bcr-2017-222725. doi: 10.1136/bcr-2017-222725.
A 78-year-old man with a history of benign prostatic hyperplasia presented with double vision, facial pain, altered taste and headache for 7 weeks. Neurological exam was notable for palsies of the right V, VI, VII and XII cranial nerves. An expansive clival mass and multiple lesions in the vertebra were found on MRI. Radionuclide studies showed extensive tumour burden in his liver and peritoneum. His serologies showed normal carcinoembryonic antigen and carbohydrate antigen 19-9 levels and modestly elevated prostate-specific antigen, which was a red herring. Biopsy of his omentum was consistent with metastatic adenocarcinoma with immunostaining indicating an upper gastrointestinal primary tumour. The patient underwent several cycles of radiation therapy, but ultimately elected to pursue hospice care. This case demonstrates the presentation of multiple cranial neuropathies from a clival mass and an unusual primary source from an upper gastrointestinal tumour.
一名78岁男性，有良性前列腺增生病史，出现复视、面部疼痛、味觉改变和头痛7周。神经系统检查显示右侧第V、VI、VII和XII颅神经麻痹。MRI发现斜坡有一占位性肿块及椎体多发病变。放射性核素检查显示肝脏和腹膜有广泛肿瘤负荷。他的血清学检查显示癌胚抗原和糖类抗原19-9水平正常，前列腺特异性抗原略有升高，这是一个误导因素。大网膜活检符合转移性腺癌，免疫染色显示为上消化道原发性肿瘤。患者接受了几个周期的放射治疗，但最终选择接受临终关怀。该病例显示了斜坡肿块导致的多发性颅神经病变以及上消化道肿瘤这一不寻常的原发灶表现。
