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目的提高对肝脾卵巢转移、腹腔占位时判断原发病灶的认识。方法结合1例以肝脾卵巢转移为首发症状、癌抗原125(CA125)明显升高、癌胚抗原(CEA)正常,多家医院误诊为胆囊结石、胆囊炎、卵巢癌近1年的降结肠癌患者的病例资料进行文献复习。结果患者,女,52岁,因反复右上腹痛2年余,发现肝脾多发占位,腹盆腔多发占位及淋巴结肿大住院。多次大便常规、便隐血试验及血CEA检查均正常,CA125>1000μg/L,正电子发射计算机断层-X线计算机体层综合显像(PET-CT)检查提示卵巢癌。行TA及TAC方案化疗疗效欠佳。肠镜检查及进一步腹腔探查证实为降结肠来源的恶性肿瘤。结论降结肠癌症状为右上腹疼痛及肝脾卵巢转移者少见,大便常规及肿瘤标志物CEA检测、PET-CT对降结肠癌的诊断有一定的参考价值,确诊仍需肠镜检查。原因不明的多发腹盆腔包块应及时行腹腔探查术。
Objective To improve the understanding of the primary lesion in the transfer of liver and spleen ovary and abdominal mass. Methods A case of hepatosplenic ovarian metastasis was taken as the first symptom. The CA125 was significantly increased and the carcinoembryonic antigen (CEA) was normal. Many hospitals misdiagnosed as cholecystolithiasis, cholecystitis and ovarian cancer for nearly one year Cases of cancer patients were reviewed. Results Patients, female, 52 years old, because of repeated right upper quadrant pain more than 2 years and found that liver and spleen multiple occupancy, multiple abdominal pelvic mass and lymph node enlargement hospitalization. Repeated stool routine, occult blood test and blood CEA were normal, CA125> 1000μg / L, positron emission computed tomography-X-ray computed tomography (PET-CT) examination of ovarian cancer. TA and TAC chemotherapy regimens ineffective. Colonoscopy and further peritoneal exploration confirmed descending colon-derived malignancies. Conclusions The symptoms of ascending colon cancer are right upper quadrant pain and rare metastasis of liver and spleen, CEA test of stool and tumor markers. PET-CT has some reference value for the diagnosis of descending colon cancer. Unidentified multiple abdominal pelvic masses should be promptly performed celiac exploration.