原发灶不明的转移癌合并副肿瘤性皮肌炎1例并文献复习

A Case Report and Literature Review of Metastatic Carcinoma of Unknown Primary Complicated with Paraneoplastic Dermatomyositis

摘要: 目的：通过报告1例原发灶不明的转移癌合并副肿瘤性皮肌炎的诊疗过程，并复习相关文献，为此类患者的诊疗提供参考。方法：回顾性分析1例青壮年原发灶不明的颈部淋巴结转移癌合并副肿瘤性皮肌炎的诊疗过程及诊疗依据，并复习相关文献。结果：通过规范诊疗及多学科协作，制定了个体化的高效低毒治疗方案，使患者获得了长达8年的生存期和良好的生活质量。结论：青壮年皮肌炎患者亦需注意肿瘤的排查，副肿瘤性皮肌炎的治疗需遵循“肿瘤治疗优先”原则，肿瘤根治后皮肌炎症状可显著缓解。原发灶不明的颈部淋巴结转移癌需进行全面的影像学、血清学及病理学检查积极查找原发灶，原发灶不明确的可根据病理类型选择广谱的抗肿瘤药物治疗，积极处理并发症有助于改善生存时间及生活质量。

Abstract: Objective: To report the diagnosis and treatment of a case of metastatic carcinoma of unknown primary complicated with paraneoplastic dermatomyositis, and to review the relevant literature, so as to provide a reference for the diagnosis and treatment of such patients. Methods: The diagnosis, treatment and relevant evidence of a young and middle-aged patient with cervical lymph node metastatic carcinoma of unknown primary combined with paraneoplastic dermatomyositis were retrospectively analyzed, and the related literature was reviewed. Results: Through standardized diagnosis and treatment as well as multidisciplinary collaboration, an individualized high-efficiency and low-toxicity therapeutic regimen was formulated, enabling the patient to achieve an 8-year survival period and a good quality of life. Conclusion: Tumor screening should also be considered in young and middle-aged patients with dermatomyositis. The treatment of paraneoplastic dermatomyositis should follow the principle of “priority of tumor treatment”. Dermatomyositis symptoms can be significantly relieved after radical tumor resection. Patients with cervical lymph node metastatic carcinoma of unknown primary require comprehensive imaging, serological and pathological examinations to actively identify the primary lesion. If the primary lesion remains unidentified, broad-spectrum antitumor drugs can be selected according to the pathological type. Active management of complications helps improve survival time and quality of life.