Mizuno I, Izeki O, Nakahara S, Kawamoto K, Onga T, Matsuoka H, Sugimoto T, Matsui T, Itoh H, Chihara K
Department of Medicine, Kobe University School of Medicine.
Rinsho Ketsueki. 1998 Sep;39(9):670-5.
A 44-year-old man was admitted to our hospital because of purpura, increased serum alkaline phosphatase, and thrombocytopenia. He had undergone subtotal gastrectomy for gastric cancer 11 years earlier. A biopsy specimen of the bone marrow revealed metastatic mucin-forming, moderately differentiated adenocarcinoma. Because the primary tumor was not detected in any other organ, the gastric cancer the patient was treated for 11 years earlier was suspected as the primary tumor. Microangiopathic hemolytic anemia and disseminated intravascular coagulation developed during the clinical course, and the patient deteriorated despite treatment with anticoagulants. Finally, he died of pulmonary carcinomatous lymphangitis. Autopsy revealed a small number of adenocarcinomatous cells in the lymphoduct of the remaining stomach in spite of its mucosa being intact. We concluded that the bone marrow was infiltrated by cancer cells which originated in the stomach 11 years before. It is unclear why adenocarcinoma cells remained dormant for as long as 11 years in the gastric lymphoduct and bone marrow.
一名44岁男性因紫癜、血清碱性磷酸酶升高和血小板减少症入住我院。他11年前因胃癌接受了胃大部切除术。骨髓活检标本显示为转移性黏液形成性、中度分化腺癌。由于在其他任何器官均未检测到原发性肿瘤，怀疑该患者11年前接受治疗的胃癌为原发性肿瘤。临床过程中出现了微血管病性溶血性贫血和弥散性血管内凝血，尽管使用了抗凝剂治疗，患者病情仍恶化。最后，他死于肺转移性癌性淋巴管炎。尸检发现，尽管剩余胃的黏膜完整，但在胃淋巴管中仍有少量腺癌细胞。我们得出结论，骨髓被11年前起源于胃的癌细胞浸润。目前尚不清楚腺癌细胞为何能在胃淋巴管和骨髓中潜伏长达11年。
