内容紹介
A Case of Advanced Neuroendocrine Cell Carcinoma of the Stomach Treated with S-1 and Cisplatin Chemotherapy
Summary
A 69-year-old man presented to our hospital because of epigastric pain. A type 2 lesion was seen in the lesser curvature of the antrum of the stomach. A moderately differentiated adenocarcinoma(human epidermal growth factor receptor 2-negative)was diagnosed by biopsy. Abdominal computed tomography showed a mass shadow 52 mm in diameter in the pyloric region invading the surrounding organs, but no evidence of distant metastasis. Chemotherapy with S-1 and cisplatin(SP therapy)was initiated because of a diagnosis of locally advanced gastric cancer. After 2 courses of chemotherapy, the tumor shrinkage rate was 70%, confirming that treatment was effective. However, severe skin disorders developed, precluding the continuation of chemotherapy. Staging laparoscopy showed no evidence of peritoneal dissemination, but invasion into the superior mesenteric vein was noted. The tumor was resected by pancreaticoduodenectomy with partial resection of the venous wall. Pathological examination of the resected specimens provided a definite diagnosis of neuroendocrine cell carcinoma. As of 1 year and 7 months after surgery, there has been no observation of metastasis or recurrence. SP therapy was suggested to be a useful regimen for preoperative chemotherapy in patients with locally advanced neuroendocrine cell carcinoma.
要旨
症例は69歳,男性。心窩部痛を主訴に受診した。胃前庭部小弯に2型病変を認め,生検にて中分化型腺癌(HER2陰性)と診断された。腹部CTで胃幽門部に52 mm大の腫瘤影を認め,周囲臓器への浸潤を認めたが遠隔転移はなかった。局所進行胃癌の診断で,S-1/CDDP(SP療法)による化学療法を開始した。2コース後の評価で縮小率70%の効果が得られたが,高度な皮膚障害のため化学療法の継続は困難と判断した。審査腹腔鏡で腹膜播種は認めなかったが,上腸間膜静脈への浸潤を認め,静脈壁を一部合併切除して膵頭十二指腸切除術で切除できた。摘出標本による病理診断で神経内分泌細胞癌と確定診断した。術後1年7か月現在,転移・再発は認めていない。局所進行胃神経内分泌細胞癌に対するSP療法は,術前化学療法として有用である可能性が示唆された。
目次
Summary
A 69-year-old man presented to our hospital because of epigastric pain. A type 2 lesion was seen in the lesser curvature of the antrum of the stomach. A moderately differentiated adenocarcinoma(human epidermal growth factor receptor 2-negative)was diagnosed by biopsy. Abdominal computed tomography showed a mass shadow 52 mm in diameter in the pyloric region invading the surrounding organs, but no evidence of distant metastasis. Chemotherapy with S-1 and cisplatin(SP therapy)was initiated because of a diagnosis of locally advanced gastric cancer. After 2 courses of chemotherapy, the tumor shrinkage rate was 70%, confirming that treatment was effective. However, severe skin disorders developed, precluding the continuation of chemotherapy. Staging laparoscopy showed no evidence of peritoneal dissemination, but invasion into the superior mesenteric vein was noted. The tumor was resected by pancreaticoduodenectomy with partial resection of the venous wall. Pathological examination of the resected specimens provided a definite diagnosis of neuroendocrine cell carcinoma. As of 1 year and 7 months after surgery, there has been no observation of metastasis or recurrence. SP therapy was suggested to be a useful regimen for preoperative chemotherapy in patients with locally advanced neuroendocrine cell carcinoma.
要旨
症例は69歳,男性。心窩部痛を主訴に受診した。胃前庭部小弯に2型病変を認め,生検にて中分化型腺癌(HER2陰性)と診断された。腹部CTで胃幽門部に52 mm大の腫瘤影を認め,周囲臓器への浸潤を認めたが遠隔転移はなかった。局所進行胃癌の診断で,S-1/CDDP(SP療法)による化学療法を開始した。2コース後の評価で縮小率70%の効果が得られたが,高度な皮膚障害のため化学療法の継続は困難と判断した。審査腹腔鏡で腹膜播種は認めなかったが,上腸間膜静脈への浸潤を認め,静脈壁を一部合併切除して膵頭十二指腸切除術で切除できた。摘出標本による病理診断で神経内分泌細胞癌と確定診断した。術後1年7か月現在,転移・再発は認めていない。局所進行胃神経内分泌細胞癌に対するSP療法は,術前化学療法として有用である可能性が示唆された。