每日一题_2023.02.14

A 63-year-old smoker visits his primary care physician because of recent weight gain and worsening coughs. On physical examination the physician notes that the patient’s extremities are thinner than before, while his waist is increased in girth. The patient also has a pad of adipose tissue at the base of his neck and purple striae on his abdomen. The physician decides to run some blood tests and obtain an x-ray of the chest, which shows a central le- sion. Which of the following is the most likely diagnosis?

一名63岁的吸烟者因近期体重增加和咳嗽加重到他的初级保健医师处就诊。在体格检查时，医生注意到病人的四肢比以前瘦了，而他的腰围增加了。患者颈部底部也有脂肪组织垫，腹部有紫色条纹。医生决定做一些血液检查和胸部x光检查，这显示了一个中心病变。下列哪一项是最可能的诊断?

(A) Adenocarcinoma 腺癌

(B) Bronchial carcinoid 支气管类癌

(C) Metastatic disease affecting the lung 肺转移性疾病

(D) Small cell carcinoma 小细胞癌

(E) Squamous cell carcinoma embolism 鳞状细胞癌栓塞

答案解析：

这名患者表现出库欣综合征的体征，有水牛背和紫色条纹。库欣综合征是由皮质醇过多引起的，可能是垂体腺瘤产生过多的ACTH，肾上腺腺瘤产生过多的皮质醇，或者是肿瘤产生的异位ACTH。这名男子的吸烟史和胸片上显示的肺结节提示肺癌。加上ACTH异位产生，该患者有副肿瘤综合征，由恶性肺肿块异位产生ACTH。在上面列出的不同的肺癌组织学分类中，小细胞癌是最可能的:鳞状细胞癌和小细胞癌与吸烟史最密切相关(98%与吸烟有关)，并且两者都表现为像x线片显示的中央病变。此外，产生ACTH或ADH的肿瘤通常是小细胞癌。

正确答案：D