内容紹介
Summary
A 65-year-old man was hospitalized for gastric cancer. Abdominal computed tomography detected lower gastric cancer and invasion of the liver. Initial laboratory data showed high levels of serum AFP(2,688.6 ng/mL). He underwent distal gastrectomy with left lobectomy of the liver and cholecystectomy. Histology confirmed that the tumor consisted of 2 components: primary gastric choriocarcinoma and AFP-producing carcinoma. The pathological staging was pT4b(liver), N3aM0, Stage ⅢC. After surgery, AFP levels decreased to within the normal limits. Adjuvant chemotherapy(S-1)was administered for 1 year after the operation. Fourteen months later, PET-CT and EOB-MRI detected liver recurrence. He was treated with weekly paclitaxel(PTX)chemotherapy for the liver recurrence. After 12 courses, the tumor had disappeared. The patient was continuously treated with weekly PTX and is doing well without recurrence 24 months after the resection of the liver tumor. Co-existence of primary gastric choriocarcinoma and AFP-producing carcinoma is very rare. We report a case of liver recurrence of choriocarcinoma and AFP-producing carcinoma of the stomach showing a complete histological response after chemotherapy.
要旨
症例は65歳,男性。腹部CTにて胃から肝外側区域にわたる腫瘤を指摘され,精査にてAFP産生胃癌,肝浸潤の診断となり,手術目的に当科受診となった。術前AFPは2,688.6 ng/mLと高値を認めた。幽門側胃切除術,肝左葉切除術,胆囊摘出術を施行した。組織学的所見はchoriocarcinoma of the stomachないしAFP-producing carcinomaであった。術後AFPは基準値内となった。S-1による術後補助化学療法を開始した。術後6か月から再びAFPが緩徐に上昇,CT検索するも再発転移は指摘されず,S-1を1年間完遂した。術後1年2か月でPET-CTおよびEOB-MRIにて肝S1に再発を認め,weekly paclitaxel(PTX)を開始した。その後12コース終了時点で腫瘍は消失した。現在,術後2年4か月13コース施行,外来通院にて加療継続中である。
目次
A 65-year-old man was hospitalized for gastric cancer. Abdominal computed tomography detected lower gastric cancer and invasion of the liver. Initial laboratory data showed high levels of serum AFP(2,688.6 ng/mL). He underwent distal gastrectomy with left lobectomy of the liver and cholecystectomy. Histology confirmed that the tumor consisted of 2 components: primary gastric choriocarcinoma and AFP-producing carcinoma. The pathological staging was pT4b(liver), N3aM0, Stage ⅢC. After surgery, AFP levels decreased to within the normal limits. Adjuvant chemotherapy(S-1)was administered for 1 year after the operation. Fourteen months later, PET-CT and EOB-MRI detected liver recurrence. He was treated with weekly paclitaxel(PTX)chemotherapy for the liver recurrence. After 12 courses, the tumor had disappeared. The patient was continuously treated with weekly PTX and is doing well without recurrence 24 months after the resection of the liver tumor. Co-existence of primary gastric choriocarcinoma and AFP-producing carcinoma is very rare. We report a case of liver recurrence of choriocarcinoma and AFP-producing carcinoma of the stomach showing a complete histological response after chemotherapy.
要旨
症例は65歳,男性。腹部CTにて胃から肝外側区域にわたる腫瘤を指摘され,精査にてAFP産生胃癌,肝浸潤の診断となり,手術目的に当科受診となった。術前AFPは2,688.6 ng/mLと高値を認めた。幽門側胃切除術,肝左葉切除術,胆囊摘出術を施行した。組織学的所見はchoriocarcinoma of the stomachないしAFP-producing carcinomaであった。術後AFPは基準値内となった。S-1による術後補助化学療法を開始した。術後6か月から再びAFPが緩徐に上昇,CT検索するも再発転移は指摘されず,S-1を1年間完遂した。術後1年2か月でPET-CTおよびEOB-MRIにて肝S1に再発を認め,weekly paclitaxel(PTX)を開始した。その後12コース終了時点で腫瘍は消失した。現在,術後2年4か月13コース施行,外来通院にて加療継続中である。