以罕見下肢深部靜脈栓塞為臨床表現的原發惡性腫瘤：一病例報告

Acute Deep Venous Thrombosis as an Unusual Clinical Manifestation of Primary Cancer

造成急性下肢深部靜脈栓塞的3個病理機轉是血流鬱積，血液處於高度易凝狀態，以及靜脈血管受傷。腫瘤患者早已被證實血液具有高度易凝性，且有研究指出不明原因下肢深部靜脈栓塞的病人中，約有19%至30%的患者會在追蹤中被發現有惡性腫瘤。在本報告裏，一位46歲男性因右下肢突發性腫痛而住院，經診斷為急性右下肢深部靜脈栓塞併發肺栓塞，而接受血栓溶解劑治療。然而在住院期間經由我們一系列的檢查，意外地發現為原發性舌頭惡性鱗狀上皮細胞癌。這讓我們警覺，惡性腫瘤在下肢深部靜脈血栓中，所扮演的角色，比一般想像來得多。

The three proposed pathogeneses causing acute deep venous thrombosis (DVT) include stasis of blood flow, hypercoagulability of blood and venous endothel ial damage. In the documented s tudies there i s ev idence of hypercoagulability and hyperthrombosis of blood in patients with underlying neoplasm, with an incidence of around 19% to 30% lower leg DVT in malignancy, though this is usually clinically neglected. We encountered a 46 year-old male with sudden onset of painful swelling of the right leg. The biochemistry and the imaging studies after admission suggested diagnosis of acute deep venous thrombosis of right leg complicated by pulmonary embolism. Further imaging studies combined with pathological studies revealed primary squamous cell carcinoma of the tongue as a possible causative disease of the DVT.