壹生资讯-NEJM病例：警惕！牛肚掌与癌症密切相关

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NEJM病例：警惕！牛肚掌与癌症密切相关

2019-11-23作者：论坛报小塔资讯

肺癌牛肚掌

来源：医咖会公众号

11月14日，最新一期NEJM发布了一个病例，一名73岁女性的手掌纹理很奇怪，最终却发现更为严重的潜在健康问题：肺癌。来看一下NEJM关于该病例的报告。

患者，女性，73岁，吸烟史30包年。到皮肤诊所就诊，因其手掌瘙痒，且有疼痛性病变，最早发生在9个月前。咳嗽已有1年，过去4个月体重减轻了5公斤。

体格检查发现，手掌为牛肚样和褶皱外观，掌纹有明确分界(图A)，这种现象被称为“牛肚掌”。20世纪70年代，一位医生觉得患者的皮肤就像是牛肚和羊肚，为此取了这样一个容易记的名字。牛肚掌的出现，与癌症，尤其是肺癌和胃癌具有密切相关性。

不过并非所有癌症患者都会出现牛肚掌。某些研究人员认为癌症可能会以某种方式刺激手掌皮肤细胞的过度生成，但目前仍不清楚其发生的确切原因。

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胸部、腹部和骨盆CT发现，左肺上叶有不规则结节，纵膈淋巴结肿大。结节和纵膈淋巴结活检证实为腺癌。患者开始化疗和放疗。

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手掌牛肚样病变可通过治疗癌症来进行解决，但是该患者在化疗和使用10%尿素药膏后都未能让手掌病变消退。患者就诊后6个月，癌症进展，患者开始二线化疗方案。患者之后的情况文章未提及。

_{【文献来源】N Engl J Med 2019; 381:e35}

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