肌无力综合症翻译.docVIP

Abstract. Lambert-Eaton myasthenic syndrome LEMS is typically characterized as a paraneoplastic syndrome associ-ated with small cell lung carcinoma. The presence of LEMS in association with other neuroendocrine lung tumors, including carcinoids or large cell lung carcinoma, is highly unusual. The present case study reports the very rare case of a patient with mediastinal small cell cancer combined with LEMS. A 53-year-old man was admitted to the Bethune First Hospital with a 3-month history of weakness in the lower extremities that had become aggravated during the previous 20 days. A positron emission tomography-computed tomography CT examination demonstrated multiple enlarged, hypermetabolic lymph nodes between the vena cava and trachea, indicating the presence of inflammation. No other abnormalities were identified. A mediastinal lymph node biopsy revealed a high prevalence of small cell neuroendocrine carcinoma. The immunohistochemistry results were as follows: Ki-67 +50, meaning that 50% of the cells exhibited Ki-67 expression , cytokeratin CK; + , cluster of differentiation CD 56 + , synaptophysin + , thyroid transcriptional factor-1 + , epithelial membrane antigen + , neuron-specific enolase + , P63 weakly + , leukocyte common antigen - , CD99 - , vimentin - and CK5/6 - . Following a diagnosis of LEMS, the patient under-went one course of cisplatin + etoposide chemotherapy, which was ineffective. Subsequently, the patient underwent a different chemotherapy regimen cisplatin + etoposide + ifosfamide , which significantly improved the symptoms of myasthenia. Following completion of this treatment regimen, the primary lesion was not observed on a lung CT scan, and the mediastinal lymph nodes had clearly diminished. Subsequently, the patient underwent two courses of radiotherapy 40 Gy/22f/6W . Discussion LEMS is an autoimmune disease involving the dysregulation of acetylcholine release at the presynaptic membrane of the neuromuscular junctio