内容紹介
Summary
Orbital metastasis of gastric cancer occurs very rarely. A 76-year-old woman, who consulted another doctor with the chief complaints of palpitation, shortness of breath, and anorexia 1 month previously, was referred to our clinic for workup and treatment. Workup revealed type Ⅲ advanced gastric cancer at the lesser curvature of the gastric antrum. Biopsy revealed a diagnosis of poorly differentiated adenocarcinoma. As computed tomography suggested periaortic lymph node metastasis, a diagnosis of T4a(SE)N3aM1(LYM), cStage Ⅳ was made. Two weeks later, ptosis was observed in the right eye, and positron emission tomography-computed tomography(PET-CT)revealed metastasis to the right superior rectus muscle. No intracranial tumor progression was observed. The Cyberknife system(20 Gy/1 Fr)was used for treating the orbital tumor. Increased LYM was observed even after 2 courses of S-1 plus oxaliplatin(SOX)therapy. Therefore, weekly combination therapy of paclitaxel and ramucirumab(wPTX plus Rmab)was administered as second-line therapy. No new distal metastasis has been detected in the 10 months since the orbital metastasis development, and the patient is still alive.
要旨
胃癌の眼窩転移は極めてまれな疾患とされている。症例は76歳,女性。食思不振を主訴に,精査目的で紹介受診となった。前庭部小弯に3型進行胃癌を認め,低分化型腺癌と診断した。CT検査にて大動脈周囲リンパ節転移が疑われ,T4a(SE)N3aM1(LYM),cStage Ⅳと診断した。幽門狭窄に対して胃空腸バイパス術を施行し化学療法を導入した。術後2週間で右の眼瞼下垂を認め,PET-CTにて右上直筋転移と診断し,サイバーナイフ(20 Gy/1 Fr)を施行した。化学療法はSOX療法を2コース施行するも大動脈周囲リンパ節と鎖骨上窩リンパ節の増大を認め,second-lineとしてwPTX+Rmab療法に変更した。眼窩転移発症後10か月を経過しているが新たな遠隔転移巣は認めず治療継続中である。
目次
Orbital metastasis of gastric cancer occurs very rarely. A 76-year-old woman, who consulted another doctor with the chief complaints of palpitation, shortness of breath, and anorexia 1 month previously, was referred to our clinic for workup and treatment. Workup revealed type Ⅲ advanced gastric cancer at the lesser curvature of the gastric antrum. Biopsy revealed a diagnosis of poorly differentiated adenocarcinoma. As computed tomography suggested periaortic lymph node metastasis, a diagnosis of T4a(SE)N3aM1(LYM), cStage Ⅳ was made. Two weeks later, ptosis was observed in the right eye, and positron emission tomography-computed tomography(PET-CT)revealed metastasis to the right superior rectus muscle. No intracranial tumor progression was observed. The Cyberknife system(20 Gy/1 Fr)was used for treating the orbital tumor. Increased LYM was observed even after 2 courses of S-1 plus oxaliplatin(SOX)therapy. Therefore, weekly combination therapy of paclitaxel and ramucirumab(wPTX plus Rmab)was administered as second-line therapy. No new distal metastasis has been detected in the 10 months since the orbital metastasis development, and the patient is still alive.
要旨
胃癌の眼窩転移は極めてまれな疾患とされている。症例は76歳,女性。食思不振を主訴に,精査目的で紹介受診となった。前庭部小弯に3型進行胃癌を認め,低分化型腺癌と診断した。CT検査にて大動脈周囲リンパ節転移が疑われ,T4a(SE)N3aM1(LYM),cStage Ⅳと診断した。幽門狭窄に対して胃空腸バイパス術を施行し化学療法を導入した。術後2週間で右の眼瞼下垂を認め,PET-CTにて右上直筋転移と診断し,サイバーナイフ(20 Gy/1 Fr)を施行した。化学療法はSOX療法を2コース施行するも大動脈周囲リンパ節と鎖骨上窩リンパ節の増大を認め,second-lineとしてwPTX+Rmab療法に変更した。眼窩転移発症後10か月を経過しているが新たな遠隔転移巣は認めず治療継続中である。