Yang Yan-Hui, Deng Qing, Yang Tian-Bao, Gui Yang, Zhang Yu-Xiang, Liu Jiang-Bo, Deng Qian, Liu Wei-Feng, Sun Jun-Jun
Department of Hepatobiliary Surgery.
Department of Pathology.
Medicine (Baltimore). 2019 Jul;98(30):e16332. doi: 10.1097/MD.0000000000016332.
Multiple primary carcinoma (MPM) refers to simultaneous or successive occurrence of ≥2 types of primary malignant tumors in a single organ or in different organs of the same individual. It is rarely seen in clinical practice. Among the various types of MPM, hilar cholangiocarcinoma combined with gastric cancer is extremely rare.
The patient was a 61-year-old man who was admitted to our hospital due to upper abdominal discomfort and yellow-stained skin mucosa for 9 days.
Preoperative diagnosis: Considering the typical preoperative painless jaundice as well as his clinical imaging report, the patient received the following preoperative diagnosis: obstructive jaundice, type IV hilar cholangiocarcinoma based on Bismuth-Corlette classification, and no intrahepatic distant metastasis. Intraoperative diagnosis: The results of intraoperative snap freezing and laboratory examination indicated gastric adenocarcinoma. Therefore, the patient received an intraoperative diagnosis of obstructive jaundice, hilar cholangiocarcinoma, and gastric cancer. Postoperative pathological diagnosis: Postoperative pathological examination of the gastric lesion revealed the following results: ulcerative, moderately differentiated gastric adenocarcinoma and intestinal type in the Lauren classification of stomach cancer; moderately differentiated adenocarcinoma of the bile duct.
Surgical resection operation was carried out and the patient received chemotherapy after operation. But we could not strictly follow the relevant clinical guidelines to perform standardized operations and provide comprehensive treatment because of his economic situation, psychological factors, and the current medical environment in China.
The patient did not receive standardized postoperative therapy. Although he lived and worked normally for 8 months after the operation, he died 10 months after surgery.
This report reminds us to pay close attention to the likelihood of MPM and other low-incidence diseases. The physicians and imaging clinicians should explore all clinical possibilities to avoid misdiagnosis of this rare disease and formulate effective treatment plans to maximize the therapeutic benefits for the patient.
多原发性癌（MPM）是指在同一个体的单个器官或不同器官中同时或相继出现≥2种原发性恶性肿瘤。在临床实践中较为少见。在各种类型的MPM中，肝门部胆管癌合并胃癌极为罕见。
患者为一名61岁男性，因上腹部不适及皮肤黏膜黄染9天入院。
术前诊断：考虑到典型的术前无痛性黄疸以及其临床影像报告，患者术前诊断如下：梗阻性黄疸，基于Bismuth-Corlette分类的IV型肝门部胆管癌，无肝内远处转移。术中诊断：术中快速冰冻及实验室检查结果提示胃腺癌。因此，患者术中诊断为梗阻性黄疸、肝门部胆管癌及胃癌。术后病理诊断：胃病变的术后病理检查结果如下：溃疡型，Lauren胃癌分类中的中分化胃腺癌及肠型；胆管中分化腺癌。
进行了手术切除，患者术后接受化疗。但由于其经济状况、心理因素及中国当前的医疗环境，我们未能严格遵循相关临床指南进行标准化手术及提供综合治疗。
患者未接受标准化的术后治疗。虽然术后8个月生活及工作正常，但术后10个月死亡。
本报告提醒我们要密切关注MPM及其他低发病率疾病的可能性。内科医生及影像科临床医生应探索所有临床可能性，以避免误诊这种罕见疾病，并制定有效的治疗方案，为患者最大化治疗效益。
