Disfiguring Nasal Metastasis from Colorectal Adenocarcinoma: A Case Report
Disfiguring Nasal Metastasis from Colorectal Adenocarcinoma: A Case Report
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结直肠腺癌鼻转移造成的毁容：一例报告
DOI：
10.1067/mhn.2001.115662
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
M. Politi
中科院分区：
文献类型：
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作者：
M. Robiony;F. Polini;F. Costa;M. Politi
1996年5月，一名56岁妇女为治疗C1 - G2型乙状结肠直肠癌，接受了乙状结肠前切除术。术后随访发现同步肝转移，累及III、V、VI、VII肝节段。1996年11月，病人住院并接受手术切除肝转移灶。术后2年未见肿瘤治愈。1998年11月，病人再次入院。计算机断层扫描（CT）和核磁共振扫描证实了左肝和左肺的异时性转移。手术吻合口未见病变。患者客观检查发现右鼻前庭有小病变，患者先前仅感觉触摸有轻微肿胀，无任何主观症状。该肿块宽1厘米，被健康皮肤覆盖并固定在深层组织上。为了明确病变的性质和起源，进行了经鼻活检。组织学报告显示结直肠腺癌浸润伴血管浸润。自1999年2月起，患者于5周内接受鼻部外束放射治疗7000 cGy，化疗周期1次。2个月后就诊时，患者出现巨大变形性肿胀（图1A），占据整个右半边脸，大面积累及上颌窦、眼眶和口腔，舌向外侧偏移。CT扫描（图1B）显示一个巨大的肿块占据了口腔、眼眶、上颌窦和筛窦，并到达蝶窦和颅底。患者1个月后死亡。讨论
In May 1996, a 56-year-old woman underwent a sigmorectal anterior resection in order to treat a C1 G2 sigmorectal carcinoma. During postsurgical follow-up synchronous liver metastasis were found, involving III, V, VI, and VII liver segments. In November 1996, the patient was hospitalized and underwent a surgical excision of liver metastasis. Postsurgical examination did not find curing of tumor disease during the next 2 years. In November 1998, the patient was admitted again. Metachronous metastasis to the left liver and lung was confirmed by computed tomography (CT) and nuclear magnetic resonance scans. No lesions were found along the surgical anastomosis. Objective patient examination revealed a small lesion of the right nasal vestibule, which the patient previously perceived only as a little swelling to the touch without any subjective symptoms. This mass was 1 cm wide, covered with healthy skin and fixed to the deep tissue. In order to clarify the nature and origin of the lesion, a transnasal biopsy was performed. Histologic report demonstrated infiltration by colorectal adenocarcinoma constant with vascular invasion. Since February 1999, the patient received 7000 cGy of external beam radiation to the nose in 5 weeks and underwent 1 chemotherapy cycle. When the patient was seen for clinical examination 2 months later, she showed an huge deforming swelling (Fig 1A) that occupied the entire right half of her face, with massive involvement of the maxillary sinus, orbit, and oral cavity, diverting the tongue laterally. CT scan (Fig 1B) showed an enormous mass that occupied oral cavity, orbit, maxillary, and ethmoidal sinuses, reaching also the sphenoidal sinus and skull base. The patient died 1 month later. DISCUSSION