内容紹介
Summary
A 74-year-old man was referred to our hospital because of a gastric tumor. A Borrmann type 2 gastric tumor was found on upper gastrointestinal endoscopy, but tissue biopsy indicated only necrotic tissue and the preoperative diagnosis was difficult. Contrast CT and FDG-PET revealed lymphadenopathy at multiple sites accompanied by high accumulation of FDG in the peri-gastric lymph nodes, left upper collarbicular fossa, bilateral hilar ganglia, and longitudinal cauda. Because the tumor was strongly suspected to be gastric cancer or malignant lymphoma, distal gastrectomy was performed. The tumor was finally diagnosed as a poorly differentiated adenocarcinoma with multiple lymph node metastasis. S-1 plus cisplatin therapy was administered as first-line chemotherapy, and paclitaxel(PTX)plus ramucirumab(RAM)therapy was administered as second-line chemotherapy. PTX plus RAM therapy was effective, and the patient achieved complete remission(CR), as observed on imaging. However, because adverse events such as numbness in the periphery of the limbs were noted, PTX plus RAM therapy was discontinued per the patient's request. Currently, 13 months since the interruption of treatment, the CR has been maintained, as determined on imaging.
要旨
症例は74歳,男性。上部消化管内視鏡で前庭部前壁にBorrmann 2型の腫瘍を認めるも,組織生検では壊死組織のみで術前診断は困難であった。造影CT検査およびFDG-PET検査にて,胃周囲リンパ節,左鎖骨上窩・両側肺門・縦隔内にFDGの高集積を伴うリンパ節腫大を多数認めた。胃癌あるいは悪性リンパ腫の疑いで,確定診断および穿孔予防のため幽門側胃切除を行い,手術標本から低分化腺癌と診断した。一次治療としてS-1+cisplatin療法,二次治療としてpaclitaxel(PTX)+ramucirumab(RAM)療法を施行,PTX+RAM療法が著効し画像的complete remission(CR)となった。しかし四肢末梢のしびれなどの有害事象を認め,5コース終了時点で患者の希望により治療を中断し,外来で経過観察を行っている。治療中断から13か月が経過した現在でも画像的CRを維持している。
目次
A 74-year-old man was referred to our hospital because of a gastric tumor. A Borrmann type 2 gastric tumor was found on upper gastrointestinal endoscopy, but tissue biopsy indicated only necrotic tissue and the preoperative diagnosis was difficult. Contrast CT and FDG-PET revealed lymphadenopathy at multiple sites accompanied by high accumulation of FDG in the peri-gastric lymph nodes, left upper collarbicular fossa, bilateral hilar ganglia, and longitudinal cauda. Because the tumor was strongly suspected to be gastric cancer or malignant lymphoma, distal gastrectomy was performed. The tumor was finally diagnosed as a poorly differentiated adenocarcinoma with multiple lymph node metastasis. S-1 plus cisplatin therapy was administered as first-line chemotherapy, and paclitaxel(PTX)plus ramucirumab(RAM)therapy was administered as second-line chemotherapy. PTX plus RAM therapy was effective, and the patient achieved complete remission(CR), as observed on imaging. However, because adverse events such as numbness in the periphery of the limbs were noted, PTX plus RAM therapy was discontinued per the patient's request. Currently, 13 months since the interruption of treatment, the CR has been maintained, as determined on imaging.
要旨
症例は74歳,男性。上部消化管内視鏡で前庭部前壁にBorrmann 2型の腫瘍を認めるも,組織生検では壊死組織のみで術前診断は困難であった。造影CT検査およびFDG-PET検査にて,胃周囲リンパ節,左鎖骨上窩・両側肺門・縦隔内にFDGの高集積を伴うリンパ節腫大を多数認めた。胃癌あるいは悪性リンパ腫の疑いで,確定診断および穿孔予防のため幽門側胃切除を行い,手術標本から低分化腺癌と診断した。一次治療としてS-1+cisplatin療法,二次治療としてpaclitaxel(PTX)+ramucirumab(RAM)療法を施行,PTX+RAM療法が著効し画像的complete remission(CR)となった。しかし四肢末梢のしびれなどの有害事象を認め,5コース終了時点で患者の希望により治療を中断し,外来で経過観察を行っている。治療中断から13か月が経過した現在でも画像的CRを維持している。