内容紹介
A Case of Double Lung and Gastric Cancer Involving Para-Aortic Lymph Node Metastasis with Difficult Preoperative Diagnosis
Summary
A man in his 60s was admitted to our hospital with anemia. An endoscopic examination revealed advanced gastric cancer. CT revealed peri-gastric and para-aortic lymphadenopathy, and a nodular shadow(20 mm)in the lower lobe of the right lung. PET-CT revealed abnormal uptake in the para-aortic lymph node and stomach wall and the nodular shadow in the right lung. A bronchoscopy revealed pulmonary adenocarcinoma. From the above, he was diagnosed with gastric cancer(cT4a, cN2, cM1, cStage Ⅳ)and lung cancer(cT2a, cN0, cM0, cStage ⅠB). Because of gastric bleeding, we decided to operate on the gastric cancer before the lung cancer. First, total gastrectomy, splenectomy, and cholecystectomy were performed and then dissection of lymph node No. 16 was performed. Histopathological examination indicated that lymph node No. 16 was common to lung cancer, so the final diagnosis was gastric cancer(pT4a, pN0, cM0, fStage ⅡA)and lung cancer(cT2a, cN0, pM1, fStage Ⅳ). In this case, lymphadenectomy of No. 16 in the first and pathological diagnosis during surgery could help us avoid splenectomy and cholecystectomy, and could reduce invasion.
要旨
症例は60歳台,男性。貧血精査目的で当院を受診した。上部内視鏡検査で胃癌と診断された。CT検査で小弯リンパ節,大動脈周囲リンパ節の腫大,右肺下葉に20 mm大の結節影を認めた。PET-CT検査では胃体上部後壁,大動脈周囲リンパ節,右肺下葉の結節影にFDGの異常集積を認めた。気管支鏡生検で肺腺癌と診断された。以上より胃癌,cT4a,cN2,cM1(LYM No. 16a2),cStage Ⅳ,肺癌,cT2a,cN0,cM0,cStage ⅠBと診断した。胃出血を伴うため胃癌の手術を先行し,二期的に肺癌の手術の方針とした。手術は胃全摘,脾臓摘出,胆嚢摘出を施行した後,No. 16a2リンパ節を郭清した。病理組織学的検査でNo. 16a2リンパ節は免疫染色TTF-1,Napsin Aに濃染され,肺癌由来と診断した。最終診断は胃癌,pT4a,pN0,cM0,fStage ⅡA,肺癌,cT2a,cN0,pM1(LYM No. 16a2),fStage Ⅳであった。今回のような肺癌と胃癌の重複癌に大動脈周囲リンパ節転移を伴った症例では,先にNo. 16リンパ節郭清を行って術中迅速病理診断を行うことで,脾臓摘出,胆嚢摘出を回避し侵襲を低減できる可能性がある。
目次
Summary
A man in his 60s was admitted to our hospital with anemia. An endoscopic examination revealed advanced gastric cancer. CT revealed peri-gastric and para-aortic lymphadenopathy, and a nodular shadow(20 mm)in the lower lobe of the right lung. PET-CT revealed abnormal uptake in the para-aortic lymph node and stomach wall and the nodular shadow in the right lung. A bronchoscopy revealed pulmonary adenocarcinoma. From the above, he was diagnosed with gastric cancer(cT4a, cN2, cM1, cStage Ⅳ)and lung cancer(cT2a, cN0, cM0, cStage ⅠB). Because of gastric bleeding, we decided to operate on the gastric cancer before the lung cancer. First, total gastrectomy, splenectomy, and cholecystectomy were performed and then dissection of lymph node No. 16 was performed. Histopathological examination indicated that lymph node No. 16 was common to lung cancer, so the final diagnosis was gastric cancer(pT4a, pN0, cM0, fStage ⅡA)and lung cancer(cT2a, cN0, pM1, fStage Ⅳ). In this case, lymphadenectomy of No. 16 in the first and pathological diagnosis during surgery could help us avoid splenectomy and cholecystectomy, and could reduce invasion.
要旨
症例は60歳台,男性。貧血精査目的で当院を受診した。上部内視鏡検査で胃癌と診断された。CT検査で小弯リンパ節,大動脈周囲リンパ節の腫大,右肺下葉に20 mm大の結節影を認めた。PET-CT検査では胃体上部後壁,大動脈周囲リンパ節,右肺下葉の結節影にFDGの異常集積を認めた。気管支鏡生検で肺腺癌と診断された。以上より胃癌,cT4a,cN2,cM1(LYM No. 16a2),cStage Ⅳ,肺癌,cT2a,cN0,cM0,cStage ⅠBと診断した。胃出血を伴うため胃癌の手術を先行し,二期的に肺癌の手術の方針とした。手術は胃全摘,脾臓摘出,胆嚢摘出を施行した後,No. 16a2リンパ節を郭清した。病理組織学的検査でNo. 16a2リンパ節は免疫染色TTF-1,Napsin Aに濃染され,肺癌由来と診断した。最終診断は胃癌,pT4a,pN0,cM0,fStage ⅡA,肺癌,cT2a,cN0,pM1(LYM No. 16a2),fStage Ⅳであった。今回のような肺癌と胃癌の重複癌に大動脈周囲リンパ節転移を伴った症例では,先にNo. 16リンパ節郭清を行って術中迅速病理診断を行うことで,脾臓摘出,胆嚢摘出を回避し侵襲を低減できる可能性がある。