Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
World J Surg Oncol. 2010 Nov 24;8:104. doi: 10.1186/1477-7819-8-104.
Late onset of peritoneal recurrence of gastric cancer more than 10 years after surgery is extremely rare, and only three cases have been reported. We present the case of a 61-year-old man who was diagnosed finally with peritoneal recurrence of gastric cancer 20 years after primary curative resection. As a result of small-bowel obstruction caused by peritoneal recurrence, diverting ileostomy with partial ileal resection was performed. The resected specimen revealed tubular adenocarcinoma that resembled the primary gastric cancer. The clinical course after the second operation was unfavorable and systemic chemotherapy had no effect. He died at 62 years of age, 21 years and 7 months after initial gastrectomy. Immunohistochemical analysis using antibodies against proliferating cell nuclear antigen (PCNA), Ki-67, and p53 was performed to investigate the phenotype of primary and recurrence cancer. Protein expression of proliferation markers such as PCNA and Ki-67 was down-regulated, but p53 was overexpressed at the site of recurrence. These data suggest that late peritoneal recurrence has a low proliferation rate and is resistant to chemoradiotherapy. In conclusion, we present late onset of peritoneal recurrence of gastric cancer more than 20 years after primary surgery, and speculate on the mechanism of late-onset recurrence in our case.
胃癌术后 10 年以上腹膜复发极为罕见，仅报道过 3 例。我们报告了 1 例 61 岁男性患者，他在原发性根治性切除术后 20 年最终被诊断为腹膜复发胃癌。由于腹膜复发导致小肠梗阻，行预防性回肠造口术和部分回肠切除术。切除标本显示管状腺癌，类似于原发性胃癌。第二次手术后的临床过程不佳，全身化疗无效。他在初始胃切除术后 21 年零 7 个月时去世，享年 62 岁。使用针对增殖细胞核抗原（PCNA）、Ki-67 和 p53 的抗体进行免疫组织化学分析，以研究原发性和复发性癌症的表型。增殖标志物如 PCNA 和 Ki-67 的蛋白表达下调，但在复发部位 p53 过表达。这些数据表明，晚期腹膜复发具有低增殖率，对放化疗有抗性。总之，我们报告了原发性手术后 20 年以上的胃癌腹膜复发的晚期发病，并推测了我们病例中晚期复发的机制。
