内容紹介
A Hematogenous Metastasis from Scirrhous Gastric Cancer to the Uterus
Summary
A 46-year-old woman was referred to our hospital because of nausea. Endoscopy revealed scirrhous gastric cancer, and abdominal computed tomography revealed peritoneal dissemination. She was diagnosed with Stage Ⅳ gastric cancer and treated with S-1 plus CDDP combination chemotherapy. After 4 courses of chemotherapy, the primary tumor and peritoneal dissemination were considered clinically stable, but the uterus grew rapidly. She was diagnosed as having uterine metastasis based on cervical and endometrial smear class Ⅴ cytology. As the chemotherapy was not effective for the uterine lesions, total hysterectomy and bilateral salpingo-oophorectomy were performed. Histological findings showed a poorly differentiated cancer with vascular emboli. Uterine metastases are an important consideration in women with scirrhous gastric cancer, and we recommend palliative hysterectomy for chemotherapy-resistant metastases if the primary tumor and other metastases are controlled.
要旨
症例は46歳,女性。心窩部不快感を主訴に当院を受診した。上部消化管内視鏡検査でスキルス胃癌があり,腹部CT検査では腹膜播種を認め,切除不能進行胃癌と診断した。SP療法を4コース施行後,胃病巣と腹膜播種はSDを維持したが,子宮病変の急速増大を認めた。子宮頸部・内膜細胞診はclass Ⅴで,化学療法不応の胃癌子宮転移と診断し,減量手術を施行した。摘出標本は子宮筋腫様腫瘤で,病理組織学的所見では腫瘍塞栓を伴う低分化腺癌の血行性転移であった。術後6か月まで全身状態良好で化学療法を施行したが,癌性DICで急逝した。若年女性のスキルス胃癌症例の子宮増大は,まれではあるが子宮転移の可能性を念頭に置くべきである。
目次
Summary
A 46-year-old woman was referred to our hospital because of nausea. Endoscopy revealed scirrhous gastric cancer, and abdominal computed tomography revealed peritoneal dissemination. She was diagnosed with Stage Ⅳ gastric cancer and treated with S-1 plus CDDP combination chemotherapy. After 4 courses of chemotherapy, the primary tumor and peritoneal dissemination were considered clinically stable, but the uterus grew rapidly. She was diagnosed as having uterine metastasis based on cervical and endometrial smear class Ⅴ cytology. As the chemotherapy was not effective for the uterine lesions, total hysterectomy and bilateral salpingo-oophorectomy were performed. Histological findings showed a poorly differentiated cancer with vascular emboli. Uterine metastases are an important consideration in women with scirrhous gastric cancer, and we recommend palliative hysterectomy for chemotherapy-resistant metastases if the primary tumor and other metastases are controlled.
要旨
症例は46歳,女性。心窩部不快感を主訴に当院を受診した。上部消化管内視鏡検査でスキルス胃癌があり,腹部CT検査では腹膜播種を認め,切除不能進行胃癌と診断した。SP療法を4コース施行後,胃病巣と腹膜播種はSDを維持したが,子宮病変の急速増大を認めた。子宮頸部・内膜細胞診はclass Ⅴで,化学療法不応の胃癌子宮転移と診断し,減量手術を施行した。摘出標本は子宮筋腫様腫瘤で,病理組織学的所見では腫瘍塞栓を伴う低分化腺癌の血行性転移であった。術後6か月まで全身状態良好で化学療法を施行したが,癌性DICで急逝した。若年女性のスキルス胃癌症例の子宮増大は,まれではあるが子宮転移の可能性を念頭に置くべきである。