CUTANEOUS METASTATIC ADENOCARCINOMA OF GALLBLADDER ORIGIN PRESENTING AS CARCINOMA OF UNKNOWN PRIMARY
CUTANEOUS METASTATIC ADENOCARCINOMA OF GALLBLADDER ORIGIN PRESENTING AS CARCINOMA OF UNKNOWN PRIMARY
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原发灶不明的胆囊源性皮肤转移性腺癌
DOI：
10.1111/j.1365-4362.1995.tb03620.x
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发表时间：
1995
影响因子：
3.6
通讯作者：
M. Milinković
中科院分区：
文献类型：
--
作者：
A. Krunic;N. Martinović;E. Calonje;M. Milinković
1990年11月，一名45岁的男子在贝尔格莱德医学院皮肤科首次就诊。参考诊断为多发性角化棘皮瘤。患者在入院前2周一直状况良好。两个月前，有人在当地医院看到他抱怨背痛。当时在他的头部和颈部发现多个皮下结节。他们自1990年6月以来一直存在，首先出现在右耳前区。随后，前额、上臂和背部都出现了这些伤痕。所有这些病灶都逐渐增大，显示中央脐状和结痂。其余体格检查均在正常范围内。入院皮肤科后，查体呼吸规律（10次/分），脉搏74次/分，心血管系统及肺部检查结果正常。未听到血管杂音，颈动脉、桡动脉、股动脉和足背动脉搏动为1+且对称。腹部柔软，除肝脏轻微肿大伴结节状边界外，未发现器官肿大。直肠检查正常，愈创木脂阴性。皮肤检查显示头皮、前额、上臂、胸部、前腹部和大腿上有许多直径为0.5 - 1.5 cm的肿胀、坚硬、固定的皮肤和皮下结节（图1）。腋窝和下颌下区域存在淋巴结病。实验室检查显示以下值：血清丙氨酸氨基转移酶（S-AST）58单位（正常8-27）;血清丙氨酸氨基转移酶（S-ALT）180单位（正常8-30）;碱性磷酸酶362单位（正常23-75）;直接胆红素211.2 pmol/L（正常至8.6| jmol/L），总胆红素213.7（jmol/L（正常3.4-23.9），纤维蛋白原4.4 g/L（正常2.0-4.0），WBC 11.9 X 10%，分类细胞计数为80%多形核白细胞，2%带状细胞，13%淋巴细胞和5%单核细胞。以下值为阴性或正常：血清钠、血清钾、血清氯、二氧化碳、血尿素氮、肌酐、葡萄糖-葡萄糖（glu-）
In November 1990, a 45-year-old man was seen for the first time at the Department of Dermatology of the medical school in Belgrade. The referring diagnosis was multiple keratoacanthomas. The patient had been well until 2 weeks before his admission to the hospital. Two months earlier he was seen at the local hospital complaining of back pain. At that time multiple subcutaneous nodules were noted on his head and neck. They had been present since June 1990, having first appeared in the right preauricular area. They had subsequently developed on the forehead, upper arms, and back. All these lesions had progressively enlarged, showing central umbilication and crusting. The rest of the physical examination was in the normal range. After admission to the Department of Dermatology, the physical examination showed regular respirations (10/min) and pulse 74 beats/min. The findings in the cardiovascular system and lungs were normal. No vascular bruits were heard and carotid, radial, femoral, and dorsalis pedis artery pulses were 1+ and symmetrical. The abdomen was soft, with no organomegaly noted, except for slight enlargement of the liver with a nodular border. Rectal examination was normal and guaiac-negative. The examination of the skin showed numerous, erythematous, firm, fixed, cutaneous and subcutaneous nodules (Fig. 1), measuring from 0.5 to 1.5 cm in diameter, on the scalp, forehead, upper arms, chest, anterior abdomen, and thighs. Lymphadenopathy was present in the axillary and submandibular regions. Laboratory studies disclosed the following values: serum aspartateaminotransferase (S-AST) 58 units (normal 8-27); serum alanineaminotransferase (S-ALT) 180 units (normal 8-30); alkaline phosphatase 362 units (normal 23-75); bilirubin direct 211.2 pmol/L (normal to 8.6 |jmol/L), bilirubin total 213.7 (jmol/L (normal 3.4-23.9), fibrinogen 4.4 g/L (normal 2.0-4.0), WBC 11.9 X 10% with a differential cell count of 80% polymorphonuclear leucoyctes, 2% band cells, 13% lymphocytes, and 5% monocytes. The following values were either negative or normal: serum sodium, serum potassium, serum chloride, carbon dioxide, blood urea nitrogen, creatinine, glu-