Ohhinata Ryouki, Iwasaki Yoshiaki, Ohashi Manabu, Iwanaga Tomohiro, Takahashi Keiichi, Yamaguchi Tatsuro, Matsumoto Hiroshi, Nakano Daisuke, Maeda Yoshiharu, Sasaki Eisaku
Dept. of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital.
Gan To Kagaku Ryoho. 2010 Nov;37(12):2508-10.
Gastric endocrine cell carcinoma is known to be highly malignant with a poor prognosis, and no standard treatment has been established. We experienced a case of gastric endocrine cell carcinoma with liver and lymph node metastases. The lesions became resectable after chemotherapy with S-1/cisplatin (CDDP). The patient was a 68-year-old male. He had gastrointestinal endoscopy for screening without complains. The endoscopy findings showed that a type 3 gastric cancer on lesser curvature of ventricular angle of the stomach, and was histologically diagnosed as an endocrine cell carcinoma by the biopsy specimen. A computed tomography (CT) scan showed metastatic lesions at S2 and S3 of the liver, and No.6 lymph node enlargement. Thus he was diagnosed as gastric endocrine cell carcinoma with liver and lymph node metastases. He was treated chemotherapy with S-1/CDDP every 5 weeks. After these courses of treatment, liver and lymph node metastatic lesions had reduced in size, but the primary lesion was still remained. Then he suffered from a drug induced eruption due to S-1. We changed the chemotherapy to biweekly CPT-11/CDDP. After 21 courses, he underwent distal gastrectomy with lymph node dissection and a partial liver resection. Histological findings revealed that there were no cancer cells in removed specimens. He had treated 8 courses of CPT-11/CDDP therapy after the surgery, and survived for 5 years without recurrence.
胃内分泌细胞癌已知具有高度恶性且预后较差,目前尚未确立标准治疗方法。我们遇到一例伴有肝和淋巴结转移的胃内分泌细胞癌病例。经S-1/顺铂(CDDP)化疗后,病变变得可切除。患者为68岁男性。他因筛查进行了胃肠内镜检查,无不适主诉。内镜检查发现胃角切迹小弯侧有3型胃癌,活检标本经组织学诊断为内分泌细胞癌。计算机断层扫描(CT)显示肝脏S2和S3有转移灶,6号淋巴结肿大。因此,他被诊断为伴有肝和淋巴结转移的胃内分泌细胞癌。他每5周接受一次S-1/CDDP化疗。经过这些疗程的治疗,肝脏和淋巴结转移灶缩小,但原发灶仍存在。然后他因S-1出现药物性皮疹。我们将化疗改为每两周一次的CPT-11/CDDP。21个疗程后,他接受了远端胃切除术加淋巴结清扫和部分肝切除术。组织学检查结果显示切除标本中无癌细胞。术后他接受了8个疗程的CPT-11/CDDP治疗,存活5年无复发。