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首页> 美国卫生研究院文献>Case Reports in Oncological Medicine >Challenges in Diagnosis and Treatment of a Cervical Spinal Cord Injury Patient with Melanoma Adenocarcinoma and Hepatic and Osteolytic Metastases: Need to Implement Strategies for Prevention and Early Detection of Cancer in Spinal Cord Injury Patients
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Challenges in Diagnosis and Treatment of a Cervical Spinal Cord Injury Patient with Melanoma Adenocarcinoma and Hepatic and Osteolytic Metastases: Need to Implement Strategies for Prevention and Early Detection of Cancer in Spinal Cord Injury Patients

机译：患有黑色素瘤腺癌以及肝和骨溶解转移的颈脊髓损伤患者的诊断和治疗挑战：需要实施预防和早期发现脊髓损伤患者癌症的策略

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A male tetraplegic patient with, who had been taking warfarin, developed haematuria. Ultrasound scan revealed no masses, stones, or hydronephrosis. Urinary bladder had normal configuration with no evidence of masses or organised haematoma. Urine cytology revealed no malignant cells. Four months later, CT urography revealed an irregular mass at the base of urinary bladder. Cystoscopic biopsy revealed moderately differentiated adenocarcinoma, which contained goblet cells and pools of mucin showing strongly positive immunostaining for prostatic acid hosphatase and patchy staining for prostate specific antigen. Computed Tomography revealed multiple hypodense hepatic lesions and several osteolytic areas in femoral heads and iliac bone. With a presumptive diagnosis of prostatic carcinoma, leuprorelin acetate 3.75 mg was prescribed. This patient expired a month later. Conclusion. (i) Spinal cord injury patient, who passed blood in urine while taking warfarin, requires repeated investigations to look for urinary tract neoplasm. (ii) Anti-androgen therapy should be prescribed for 2 weeks prior to administration of gonadorelin analogue to prevent tumour flare causing bone pain, bladder outlet obstruction, uraemia, and cardiovascular risk due to hypercoagulability associated with a rapid increase in tumour burden. (iii) Spinal cord physicians should adopt a caring and compassionate approach while managing tetraplegic patients with several co-morbidities, as aggressive diagnostic tests and therapeutic procedures may lead to deterioration in the quality of life.
机译：一名服用华法令的男性四肢瘫痪患者发生了血尿。超声扫描未发现肿块，结石或肾积水。膀胱结构正常，无肿块或组织性血肿迹象。尿细胞学检查未见恶性细胞。四个月后，CT尿路造影显示膀胱底部有不规则的肿块。膀胱镜活检显示中度分化的腺癌，其中含有杯状细胞和粘蛋白池，对前列腺酸类肝素酶显示强烈的阳性免疫染色，对前列腺特异抗原的斑点染色。计算机断层扫描显示股骨头和骨有多个低密度肝损伤和多个溶骨区域。根据前列腺癌的推定诊断，处方醋酸亮丙瑞林3.75 mg。该患者一个月后死亡。结论。 （i）服用华法令时在尿中带血的脊髓损伤患者，需要反复检查以寻找尿路肿瘤。 （ii）应在服用促性腺激素类似物之前2周开具抗雄激素治疗药物，以防止因高凝性引起的肿瘤耀斑引起的骨痛，膀胱出口阻塞，尿毒症和心血管疾病风险以及与肿瘤负荷迅速增加相关的风险。 （iii）脊髓内科医师在处理患有多种合并症的四肢瘫痪患者时应采取关怀和同情的态度，因为积极的诊断测试和治疗程序可能会导致生活质量下降。

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