Kondo H, Sakai Y, Takaso T
Department of Medicine, Shimizu Kousei Hospital.
Rinsho Ketsueki. 1993 Feb;34(2):224-8.
A 74-year-old man was admitted because of swelling, pain and ecchymosis in the night lower extremity. A blood analysis revealed that Hb was 11.8g/dl, WBC 37,600/microliters, and platelet count 137.1 x 10(4)/microliters. The NAP value was high. Bone marrow examination disclosed marked megakaryocytic hyperplasia. Chromosomal analysis revealed 47, XY, +9. Hemostatic data were within normal ranges, but the 2nd aggregation of platelet by ADP was diminished. The serum beta-TG was 159, PF-4 56ng/ml, B12 1,100, UB12 BC 1,800pg/ml. Gastric fiberoscopy revealed gastric cancer and CT scan disclosed marked splenomegaly. Essential thrombocythemia (ET) coexisting with gastric cancer was diagnosed based on these examinations. He was treated with anti-platelet agents, busulfan and tegafur uracil, however thromboembolic symptoms suggesting central nervous system and peripheral vascular ischemia and gastrointestinal bleeding occurred. Among diagnostic criteria for ET established by the polycythemia vera study group, there is a category "No known cause for reactive thrombocytosis." The case reported here had gastric cancer which may have contributed to the elevated platelet count, however this case could be diagnosed as ET coexisting with gastric cancer because of the above various clinical signs and laboratory results. Although then are few reports of the coexistence of other malignancies in ET, there may be many more similar cases because of the age preponderance in ET. In order to diagnose ET more precisely, more strict diagnostic criteria are needed.
一名74岁男性因夜间下肢肿胀、疼痛和瘀斑入院。血液分析显示血红蛋白（Hb）为11.8g/dl，白细胞（WBC）37600/微升，血小板计数137.1×10⁴/微升。中性粒细胞碱性磷酸酶（NAP）值升高。骨髓检查显示巨核细胞明显增生。染色体分析显示为47，XY，+9。止血数据在正常范围内，但二磷酸腺苷（ADP）诱导的血小板二次聚集减少。血清β-血小板球蛋白（β-TG）为159，血小板第4因子（PF-4）56ng/ml，维生素B₁₂ 1100，未结合维生素B₁₂结合物（UB₁₂ BC）1800pg/ml。胃镜检查发现胃癌，计算机断层扫描（CT）显示脾脏明显肿大。根据这些检查诊断为真性红细胞增多症研究组制定的原发性血小板增多症（ET）诊断标准中，有一类是“无已知反应性血小板增多的原因”。本文报道的病例患有胃癌，这可能是血小板计数升高的原因之一，但由于上述各种临床症状和实验室检查结果，该病例可诊断为ET合并胃癌。虽然ET合并其他恶性肿瘤的报道很少，但由于ET患者年龄偏大，可能还有更多类似病例。为了更准确地诊断ET，需要更严格的诊断标准。
