内容紹介
Summary
A 70s male was referred to our hospital with anemia that was detected during a medical checkup. Upper gastrointestinal endoscopy showed advanced cardia gastric cancer. A diagnosis of pernicious anemia was made due to the macrocytic hyperchromic anemia and detection of intrinsic factor antibody. A CT scan showed fundic wall thickening and regional lymph node metastasis. After anemia improved following vitamin B12 injection, total gastrectomy with lymphadenectomy was performed. The histopathological findings showed adenocarcinoma(tub1>tub2), Type 2, pT3(SS), pN1(2/24), StageⅡB, INF b, ly1, v2, PM0, DM0, EW(+), pR1. He was administered systematic chemotherapy using S-1 for one year after surgery and has been followed up without recurrence for 5 years.
要旨
症例は70歳台,男性。体重減少を認め,検診にて貧血・便潜血陽性を指摘され,近医にて上部消化管内視鏡検査で胃噴門部に2型進行癌を認めた。CT検査で胃噴門部癌は食道浸潤を伴い所属リンパ節転移を認めた。抗内因子抗体陽性が確認され,悪性貧血に合併した胃噴門部癌と診断した。ビタミンB12静注療法により貧血が完全に軽快後,開胸開腹胃全摘術+摘脾術,D2,Roux-en-Y再建術を施行した。術後病理診断は,adenocarcinoma(tub1>tub2),Type 2,pT3(SS),pN1(2/24),StageⅡB,INF b,ly1,v2,PM0,DM0,EW(+),pR1であった。術後1年間S-1による補助化学療法を施行し,術後5年現在,無再発生存中である。
目次
A 70s male was referred to our hospital with anemia that was detected during a medical checkup. Upper gastrointestinal endoscopy showed advanced cardia gastric cancer. A diagnosis of pernicious anemia was made due to the macrocytic hyperchromic anemia and detection of intrinsic factor antibody. A CT scan showed fundic wall thickening and regional lymph node metastasis. After anemia improved following vitamin B12 injection, total gastrectomy with lymphadenectomy was performed. The histopathological findings showed adenocarcinoma(tub1>tub2), Type 2, pT3(SS), pN1(2/24), StageⅡB, INF b, ly1, v2, PM0, DM0, EW(+), pR1. He was administered systematic chemotherapy using S-1 for one year after surgery and has been followed up without recurrence for 5 years.
要旨
症例は70歳台,男性。体重減少を認め,検診にて貧血・便潜血陽性を指摘され,近医にて上部消化管内視鏡検査で胃噴門部に2型進行癌を認めた。CT検査で胃噴門部癌は食道浸潤を伴い所属リンパ節転移を認めた。抗内因子抗体陽性が確認され,悪性貧血に合併した胃噴門部癌と診断した。ビタミンB12静注療法により貧血が完全に軽快後,開胸開腹胃全摘術+摘脾術,D2,Roux-en-Y再建術を施行した。術後病理診断は,adenocarcinoma(tub1>tub2),Type 2,pT3(SS),pN1(2/24),StageⅡB,INF b,ly1,v2,PM0,DM0,EW(+),pR1であった。術後1年間S-1による補助化学療法を施行し,術後5年現在,無再発生存中である。