十二指腸出血表現之骨源性平滑肌肉瘤個案探討

A Case Study of Primary Leiomyosarcoma of Bone with Duodenal Hemorrhage

臨床上常見因長期使用非類固醇類消炎藥（non-steroidal anti-inflammatory drug, NSAID），造成上腹痛合併解黑便及頭暈症狀而至胃腸內科求治病患。本案例為62歲男性，近日因上腹悶痛合併頭暈持續3天故來院求治，初步臆斷為十二指腸糜爛性潰瘍併出血收治住院治療。身體評估發現右橈骨異常腫塊，詢問病史發現個案長期藉由服用NSAIDs緩解右前臂腫脹痠痛症狀，安排右手X光檢查及會診骨科進行右橈骨病灶處切片。十二指腸及右橈骨病灶處切片病理報告呈現相同異常梭形細胞，最終確診右橈骨骨源性平滑肌肉瘤（primary leiomyosarcoma of bone, LMSB）併十二指腸轉移。經跨團隊及院際醫療討論後，個案轉至醫學中心接受術前放射線、手術及化學藥物等治療。透過本案例探討，提醒入院時詳細完整病史詢問及身體評估有助於鑑別診斷，並可提供臨床更多元之考量，避免錯失治療黃金時間。

 

Patients who have been taking non-steroidal anti-inflammatory drugs (NSAIDs) for a long time are of-ten referred to the gastrointestinal clinics due to epigastric pain combined with melena and dizziness symptoms. The case in this study is a 62-year-old man who had epigastric pain and dizziness for three days. The initial diagnosis was duodenal erosive ulcer and hemorrhage, and the patient was admitted to hospital for treatments. The physical assessment revealed an abnormal mass in the right radius, and a medical history was found that NSAIDs were taken by the patient for a long period to relieve the swelling and soreness of the right forearm. An X-ray examination of the right hand was subsequently arranged and a consultation with the orthopaedic specialists was conducted for further conduct biopsy. The pathological report of the duodenum and right radius lesions showed the same abnormal spindle cells, therefore, the primary leiomyosarcoma of bone (LMSB) in right radius with duodenal metas-tasis was finally confirmed. Through multidisciplinary and inter-hospital medical discussions, the patient was immediately transferred to the medical center for preoperative radiotherapy followed by surgery and chemotherapy. This case study indicates the importance of performing a detailed medical history examination and physical assessment upon admission which are helpful for differential diag-nosis and can provide more clinical considerations for promptly treatments.