内容紹介
Summary
A 69-year-old man with chronic gastritis, reflux esophagitis, esophageal hiatal hernia, and history of appendicitis surgery complained of difficulty swallowing. Upper gastrointestinal endoscopy revealed a 10 cm sized Type 3 gastric cancer. Immunostaining was positive for chromogranin A(2+), synaptophysin(3+), CD56(-), and Ki-67>70%. Contrast computed tomography(CT)showed upper gastric wall thickening, and #1, #3, #7, #8a, and #11p enlarged lymph nodes but no distant metastasis. We diagnosed gastric cancer, UM, Less, Type 3, gastric neuroendocrine carcinoma, cT4aN3M0P0CY0, Stage ⅢC. We administered 2 courses of CDDP plus CPT-11 chemotherapy, and a partial response was obtained for the primary gastric lesion and lymph node metastases. We subsequently performed open distal gastrectomy, D2 lymph node dissection, and splenectomy. Pathological examination confirmed that the lesion was gastric cancer, U, Less, Type 3, gastric neuroendocrine carcinoma, MP, Ul-Ⅱ(+), int, INF b, ly2, v0, PM0, DM0, R0, ypT2N2, StageⅡB, with a therapeutic value of Grade 2. The patient was discharged on day 15 after the surgery and received 2 courses of adjuvant chemotherapy with CDDP plus CPT-11. Nine months after the surgery, metastasis of the left adrenal grand was found. We performed open left adrenal gland resection and administered adjuvant S-1 chemotherapy.
要旨
症例は69歳,男性。食物のつかえ感を主訴に近医を受診し,精査加療目的で当科へ紹介となった。上部消化管内視鏡検査にて噴門部から胃体中部小弯にかけて約10 cmの3型病変を認めた。造影CTで胃体上部小弯の前壁から後壁に造影効果の強い壁肥厚と,#1,#3,#7,#8a,#11pのリンパ節腫大を認めた。免疫染色にてchromogranin A,synaptophysin陽性,Ki-67陽性率が70%以上であり,gastric cancer,U,Less,cType 3,neuroendocrine carcinoma,cT4a,cN3,cM0,cP0,CY0,cStage ⅢCと診断した。術前化学療法としてCDDP+CPT-11を2コース施行し,腫大リンパ節の著明な縮小を認めた。開腹胃全摘術,D2郭清,脾臓摘出術を施行し,病理結果は胃癌(U,Less,Type 3,neuroendocrine carcinoma,int,INF b,ly2,v0,ypT2,ypN2,ypStageⅡB,PM0,DM0,R0),薬物治療の組織学的効果判定はGrade 2であった。術後化学療法としてCDDP+CPT-11を2コース施行した。術後9か月で左副腎に再発を認めた。開腹左副腎摘出術を施行し,現在は外来にてS-1単剤での化学療法を施行している。胃神経内分泌癌は予後不良とされているが,CDDP+CPT-11が奏効した1例を経験したので,若干の文献的考察を加え報告する。
目次
A 69-year-old man with chronic gastritis, reflux esophagitis, esophageal hiatal hernia, and history of appendicitis surgery complained of difficulty swallowing. Upper gastrointestinal endoscopy revealed a 10 cm sized Type 3 gastric cancer. Immunostaining was positive for chromogranin A(2+), synaptophysin(3+), CD56(-), and Ki-67>70%. Contrast computed tomography(CT)showed upper gastric wall thickening, and #1, #3, #7, #8a, and #11p enlarged lymph nodes but no distant metastasis. We diagnosed gastric cancer, UM, Less, Type 3, gastric neuroendocrine carcinoma, cT4aN3M0P0CY0, Stage ⅢC. We administered 2 courses of CDDP plus CPT-11 chemotherapy, and a partial response was obtained for the primary gastric lesion and lymph node metastases. We subsequently performed open distal gastrectomy, D2 lymph node dissection, and splenectomy. Pathological examination confirmed that the lesion was gastric cancer, U, Less, Type 3, gastric neuroendocrine carcinoma, MP, Ul-Ⅱ(+), int, INF b, ly2, v0, PM0, DM0, R0, ypT2N2, StageⅡB, with a therapeutic value of Grade 2. The patient was discharged on day 15 after the surgery and received 2 courses of adjuvant chemotherapy with CDDP plus CPT-11. Nine months after the surgery, metastasis of the left adrenal grand was found. We performed open left adrenal gland resection and administered adjuvant S-1 chemotherapy.
要旨
症例は69歳,男性。食物のつかえ感を主訴に近医を受診し,精査加療目的で当科へ紹介となった。上部消化管内視鏡検査にて噴門部から胃体中部小弯にかけて約10 cmの3型病変を認めた。造影CTで胃体上部小弯の前壁から後壁に造影効果の強い壁肥厚と,#1,#3,#7,#8a,#11pのリンパ節腫大を認めた。免疫染色にてchromogranin A,synaptophysin陽性,Ki-67陽性率が70%以上であり,gastric cancer,U,Less,cType 3,neuroendocrine carcinoma,cT4a,cN3,cM0,cP0,CY0,cStage ⅢCと診断した。術前化学療法としてCDDP+CPT-11を2コース施行し,腫大リンパ節の著明な縮小を認めた。開腹胃全摘術,D2郭清,脾臓摘出術を施行し,病理結果は胃癌(U,Less,Type 3,neuroendocrine carcinoma,int,INF b,ly2,v0,ypT2,ypN2,ypStageⅡB,PM0,DM0,R0),薬物治療の組織学的効果判定はGrade 2であった。術後化学療法としてCDDP+CPT-11を2コース施行した。術後9か月で左副腎に再発を認めた。開腹左副腎摘出術を施行し,現在は外来にてS-1単剤での化学療法を施行している。胃神経内分泌癌は予後不良とされているが,CDDP+CPT-11が奏効した1例を経験したので,若干の文献的考察を加え報告する。