Kamran Syed, Dilling Mattias K, Parker Nathaniel A, Alderson Joel, Tofteland Nathan D, Truong Quoc V
Department of Internal Medicine, University of Kansas School of Medicine, Wichita, KS, 67214, USA.
Department of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, MO, 64106, USA.
F1000Res. 2020 Jun 15;9:604. doi: 10.12688/f1000research.24353.2. eCollection 2020.
Primary gastric cancer remains one of the most prevalent malignancies worldwide. Often patients remain asymptomatic until it is detected at an advanced stage with a poor prognosis. Thus, it's characteristically difficult to initially diagnose until it becomes late stage, at which point prognosis becomes poor. Pernicious anemia is a classic risk factor for the development of primary gastric cancer, but is uncommonly seen in clinical practice. Over time, patients who produce the autoantibodies to intrinsic factor that cause pernicious anemia typically will present initially with clinically significant megaloblastic anemia and peripheral neuropathy. However, patients can also present with more nonspecific signs and symptoms. Thus, clinicians should remain vigilant as circulating anti-intrinsic factor antibodies only worsen the disease over time and increase the risk of developing primary gastric cancer. This report not only presents the rare concurrent diagnosis of pernicious anemia and gastric cancer, but also aims to increase clinical awareness of these two conditions' classic association because early diagnosis and treatment significantly impacts morbidity and mortality.
原发性胃癌仍然是全球最常见的恶性肿瘤之一。通常患者在晚期被检测出之前没有症状，预后较差。因此，在疾病发展到晚期之前，其特征是很难进行初步诊断，而到了晚期预后就会很差。恶性贫血是原发性胃癌发生的一个典型危险因素，但在临床实践中并不常见。随着时间的推移，产生导致恶性贫血的内因子自身抗体的患者最初通常会出现具有临床意义的巨幼细胞贫血和周围神经病变。然而，患者也可能出现更多非特异性的体征和症状。因此，临床医生应保持警惕，因为循环中的抗内因子抗体只会随着时间的推移使病情恶化，并增加患原发性胃癌的风险。本报告不仅展示了恶性贫血和胃癌罕见的同时诊断情况，还旨在提高临床对这两种疾病经典关联的认识，因为早期诊断和治疗对发病率和死亡率有重大影响。
