Gruzdev Ivan Sergeevich, Blokhin Ivan Andreevich, Lednev Aleksey Nikolaevich, Pechetov Aleksey Aleksandrovich, Makov Maksim Aleksandrovich, Esakov Yuriy Sergeevich, Arevin Artem Garrievich, Glotov Andrey Vyacheslavovich, Kаrmаzаnovsky Grigory Grigorievich
A.V. Vishnevsky National Medical Research Centre of Surgery, Bolshaya Serpukhovskaya str. 27, 117997, Moscow, Russia.
Research and Practical Clinical Centre of Diagnostics and Telemedicine Technologies, st. Srednyaya Kalitnikovskaya str. 28, 109029, Moscow, Russia.
Int J Surg Case Rep. 2019;60:363-367. doi: 10.1016/j.ijscr.2019.06.028. Epub 2019 Jun 20.
Tumors of the diaphragm are uncommon. The overwhelming number of cases is metastatic combined with metastases to the liver, lungs and other organs. Only a minority of cases are described as solitary lesions.
Fifty-five years old female with a history of radical curative surgery for pT3N0M0 endometrial cancer eight years ago was admitted to the Department of Thoracic Surgery with a feeling of discomfort in the right hypochondrium. The contrast-enhanced MDCT revealed a large, well-circumscribed lesion of the right hemidiaphragm deforming upper contour of the liver. A clear boundary between the lesion and the liver suggested former's diaphragmatic origin. PET-CT did not show any distant metastasis. Intraoperative revision revealed a tumor growing from the dome of the diaphragm with well-defined contours and without any signs of lung involvement. The diaphragmotomy was performed. The morphological study with immunohistochemistry showed an endometrial carcinoma metastasis to the diaphragm.
The diaphragm lesions can have various etiology, but a probability of tumor metastasis after a previous radical surgery should not be excluded. Preoperative differential diagnostics can be difficult, leaving surgical treatment followed by a pathology study as the most informative diagnostic method of tumor morphology.
膈肌肿瘤并不常见。绝大多数病例为转移性肿瘤,常伴有肝、肺及其他器官的转移。仅有少数病例被描述为孤立性病变。
一名55岁女性,八年前因pT3N0M0子宫内膜癌接受了根治性手术,因右季肋部不适入住胸外科。增强MDCT显示右半膈肌有一个大的、边界清晰的病变,使肝脏上缘变形。病变与肝脏之间界限清晰,提示病变起源于膈肌。PET-CT未显示任何远处转移。术中检查发现一个从膈肌顶部生长的肿瘤,轮廓清晰,无任何肺受累迹象。遂进行膈肌切开术。免疫组化的形态学研究显示为子宫内膜癌转移至膈肌。
膈肌病变可有多种病因,但既往根治性手术后肿瘤转移的可能性不应被排除。术前鉴别诊断可能困难,手术治疗后进行病理研究仍是了解肿瘤形态最具信息量的诊断方法。