Toyoda Takahide, Suzuki Hidemi, Nakajima Takahiro, Iwata Takekazu, Matsuoka Ayumu, Nishikimi Kyoko, Yonemori Yoko, Shozu Makio, Nakatani Yukio, Yoshino Ichiro
Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan.
Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Gen Thorac Cardiovasc Surg. 2018 Aug;66(8):484-487. doi: 10.1007/s11748-017-0881-y. Epub 2018 Jan 11.
We herein reported a rare case of an occult fallopian tube carcinoma first detected from the diaphragm metastasis. An 83-year-old woman who had a 30-mm tumor on the right diaphragm underwent radical resection. Pathologically, the tumor was diagnosed as a high-grade serous adenocarcinoma, suggesting metastasis from the pelvic visceral carcinoma. Although the primary site could not be detected by imaging examinations, laparoscopy revealed multiple peritoneal disseminations; therefore, total hysterectomy was performed. Finally, microscopic tumor invasion into the right fimbriae of the fallopian tube was found. A precise and detailed pathological and immunohistochemical examinations of the resected metastatic diaphragm tumor helped us obtain a proper diagnosis of the primary lesion and treat the patient appropriately. Since it is difficult to diagnose diaphragm tumors before surgery based on the anatomy, surgical options have played an important role in their treatment and diagnosis clinically.
我们在此报告一例罕见的隐匿性输卵管癌，最初是通过膈肌转移灶检测到的。一名83岁女性，右膈肌有一个30毫米的肿瘤，接受了根治性切除术。病理检查显示，该肿瘤被诊断为高级别浆液性腺癌，提示为盆腔内脏癌转移。尽管影像学检查未发现原发部位，但腹腔镜检查发现多处腹膜播散；因此，进行了全子宫切除术。最终，在显微镜下发现肿瘤侵犯右侧输卵管伞端。对切除的转移性膈肌肿瘤进行精确、详细的病理和免疫组化检查，有助于我们对原发病变做出正确诊断并对患者进行适当治疗。由于基于解剖结构在术前难以诊断膈肌肿瘤，手术选择在其临床治疗和诊断中发挥了重要作用。
