Klīniskais gadījums. Kuņģa vēzis ar ādas metastazēm un sklerodermai līdzīgo reimatisko paraneoplastisko sindromu.
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Šajā klīniskajā gadījuma autori apraksta slimnieci, kurai kuņģa vēzis izpaudās ar retām ādas metastāzēm, kas nav saistītas ar sklerodermai līdzīga paraneoplastiskā reimatiskā sindroma distanto metastāžu mehānisko iedarbību.
72 gadus veca sieviete tika nosūtīta uz slimnīcu ar sūdzībām, kas progresēja viena gada laikā. Tika aprakstītas tādas izmaiņas, kā ādas un zemādas sabiezēšana, kas lielākoties bija vērojamas ķermeņa augšdaļā – uz rokām, kakla, sejas, krūtīm un vēdera priekšējas sienas; tās izmaiņas radīja ādas kontraktūras un ierobežoja viņas kustības. Augšdelmu, kakla un krūškurvja augšdaļas rajonā bija vairāki mazi, nesāpīgi, cieti zemādas mezgliņi; arī novēroja hiperpigmentāciju kakla rajonā. Pacientei nebija Reino fenomena, teleangiektāzijas pazīmes, alopēcijas, hipopigmentācijas, muskuļu vājuma un sāpju pazīmju. Pēc turpmākas pacientes izmeklēšanas un vairāku biopsiju (kuņģa un ādas mezglu) rezultātā tika atklāta zemu diferencēta kuņģa karcinoma, izmeklēšanas brīdī - ar peritoneālo disemināciju, ascītu, ādas un zemādas metastāzēm un sklerodermai līdzīgo paraneoplastisko sindromu. Pēc sistēmiskās kuņģa vēža ārstēšanas pacientei mazinājās paraneoplastiska sindroma izpausmes, uzlabojas dzīves kvalitāte un radioloģiski iestājas slimības remisija.
In this case report, we will describe a gastric cancer case, which presented with rare manifestation of skin metastases and unrelated to the mechanical impact of distant metastases scleroderma-like paraneoplastic rheumatic syndrome. 72-year-old woman was referred to hospital with complaints gradual during the time period of one year. Skin changes included - thickening, dermal induration mostly seen on her upper body – arms, neck, face, chest and abdominal wall, causing contracture and limited movements. In the area of her upper arms, neck and upper part of her chest multiple small, painless, hard subcutaneous nodules were present and hyperpigmentation in the neck area. There were no signs of Raynaud’s phenomenon, telangiectasia, alopecia, hypopigmentation or muscle weakness and pain. Upon further examination and multiple biopsies (gastric and skin nodules) poorly differentiated gastric carcinoma was confirmed with peritoneal dissemination, ascites, cutaneous, subcutaneous metastasis and scleroderma-like paraneoplastic syndrome. After systemic treatment for gastric cancer patient showed improvement of paraneoplastic syndrome manifestations, quality of life and radiologically stable disease.
In this case report, we will describe a gastric cancer case, which presented with rare manifestation of skin metastases and unrelated to the mechanical impact of distant metastases scleroderma-like paraneoplastic rheumatic syndrome. 72-year-old woman was referred to hospital with complaints gradual during the time period of one year. Skin changes included - thickening, dermal induration mostly seen on her upper body – arms, neck, face, chest and abdominal wall, causing contracture and limited movements. In the area of her upper arms, neck and upper part of her chest multiple small, painless, hard subcutaneous nodules were present and hyperpigmentation in the neck area. There were no signs of Raynaud’s phenomenon, telangiectasia, alopecia, hypopigmentation or muscle weakness and pain. Upon further examination and multiple biopsies (gastric and skin nodules) poorly differentiated gastric carcinoma was confirmed with peritoneal dissemination, ascites, cutaneous, subcutaneous metastasis and scleroderma-like paraneoplastic syndrome. After systemic treatment for gastric cancer patient showed improvement of paraneoplastic syndrome manifestations, quality of life and radiologically stable disease.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Kuņģa vēzis, paraneoplastiskais sindroms, skleroderma, ādas metastāzes, Gastric cancer, paraneoplastic syndrome, scleroderma, cutaneous metastasis