内容紹介
Summary
A 68-year-old man presented with general fatigue due to anemia. Gastrointestinal endoscopy showed a tumor approximately 60 mm in diameter in the lesser curvature of the angle of the stomach. Large cell neuroendocrine carcinoma was diagnosed by biopsy of a tumor specimen. Computed tomography revealed bulky regional lymph node metastases, solitary liver metastasis, and left adrenal metastasis. After three courses of combined chemotherapy with S-1 and CDDP, the gastric lesion and lymph node metastases shrunk, but the liver metastasis and left adrenal metastasis enlarged. After three courses of combined chemotherapy with ramucirumab and paclitaxel, the liver metastasis and left adrenal metastasis also shrunk, and no other new metastatic lesions appeared. Accordingly, total gastrectomy with lymph nodes dissection, partial resection of the liver and left adrenalectomy were performed for a curative resection. The histological findings revealed neuroendocrine carcinoma and adenocarcinoma of the stomach. The lesions of the liver and lymph nodes were all burned out, and a tiny metastatic lesion of neuroendocrine carcinoma was left in the left adrenal gland. S-1 was administrated for 3 months after surgery. The patient has been alive for 16 months without recurrence after surgery.
要旨
症例は68歳,男性。上部消化管内視鏡検査にて胃前庭から胃体上部に至る径6 cmの3型腫瘍を認め,腫瘍生検では低分化型腺癌で内分泌細胞癌の可能性が指摘された。CT検査では所属リンパ節にbulky N2を認め,左副腎転移および孤立性肝転移が疑われた。S-1/CDDP療法を3コース施行したところ,原発巣およびリンパ節転移巣は縮小したものの左副腎転移巣および肝転移巣は増大したため,ramucirumab/paclitaxel療法を3コース施行した。これにより原発巣およびリンパ節に加えて副腎転移巣および肝転移巣の縮小を認め,また新たな転移病変は指摘されなかった。そこで胃全摘術,リンパ節郭清,肝部分切除術および左副腎摘出術を施行した。切除標本の病理組織所見では胃に内分泌細胞癌を認め,副腎にはNECの転移が確認されたが,リンパ節および肝転移巣は悪性所見を認めずburn out lesionと考えられた。術後S-1による補助化学療法を施行した。術後16か月の現在,無再発生存中である。
目次
A 68-year-old man presented with general fatigue due to anemia. Gastrointestinal endoscopy showed a tumor approximately 60 mm in diameter in the lesser curvature of the angle of the stomach. Large cell neuroendocrine carcinoma was diagnosed by biopsy of a tumor specimen. Computed tomography revealed bulky regional lymph node metastases, solitary liver metastasis, and left adrenal metastasis. After three courses of combined chemotherapy with S-1 and CDDP, the gastric lesion and lymph node metastases shrunk, but the liver metastasis and left adrenal metastasis enlarged. After three courses of combined chemotherapy with ramucirumab and paclitaxel, the liver metastasis and left adrenal metastasis also shrunk, and no other new metastatic lesions appeared. Accordingly, total gastrectomy with lymph nodes dissection, partial resection of the liver and left adrenalectomy were performed for a curative resection. The histological findings revealed neuroendocrine carcinoma and adenocarcinoma of the stomach. The lesions of the liver and lymph nodes were all burned out, and a tiny metastatic lesion of neuroendocrine carcinoma was left in the left adrenal gland. S-1 was administrated for 3 months after surgery. The patient has been alive for 16 months without recurrence after surgery.
要旨
症例は68歳,男性。上部消化管内視鏡検査にて胃前庭から胃体上部に至る径6 cmの3型腫瘍を認め,腫瘍生検では低分化型腺癌で内分泌細胞癌の可能性が指摘された。CT検査では所属リンパ節にbulky N2を認め,左副腎転移および孤立性肝転移が疑われた。S-1/CDDP療法を3コース施行したところ,原発巣およびリンパ節転移巣は縮小したものの左副腎転移巣および肝転移巣は増大したため,ramucirumab/paclitaxel療法を3コース施行した。これにより原発巣およびリンパ節に加えて副腎転移巣および肝転移巣の縮小を認め,また新たな転移病変は指摘されなかった。そこで胃全摘術,リンパ節郭清,肝部分切除術および左副腎摘出術を施行した。切除標本の病理組織所見では胃に内分泌細胞癌を認め,副腎にはNECの転移が確認されたが,リンパ節および肝転移巣は悪性所見を認めずburn out lesionと考えられた。術後S-1による補助化学療法を施行した。術後16か月の現在,無再発生存中である。