Konishi Hirotaka, Komatsu Shuhei, Ichikawa Daisuke, Sougawa Akira, Okamoto Kazuma, Shiozaki Atsushi, Fujiwara Hitoshi, Murayama Yasutoshi, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Ochiai Toshiya, Kokuba Yukihito, Otsuji Eigo
Dept. of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Gan To Kagaku Ryoho. 2012 Nov;39(12):2330-2.
Sarcoidosis is an idiopathic systemic disease with non-caseating granuloma that is reported to occur concomitantly with various malignant tumors. We report here a case of advanced gastric cancer with sarcoidosis, for which precise preoperative diagnosis was difficult. A 69-year-old woman was diagnosed with a far-advanced gastric cancer because multiple intra-abdominal and intra-thoracic lymph node swellings and a tumorous lesion in the spleen were detected by multidetector computed tomography and fluorodeoxyglucose positron emission tomography. However, these multiple changes might be derived from sarcoidosis, because the multiple lymph node swellings were nonspecific changes for gastric cancer. With appropriate informed consent, surgery was selected in order to accurately confirm the stage of progression. Consequently, these changes were shown to not be metastatic, and curative surgery was performed. In conclusion, careful examination and a reasonable treatment strategy are important for avoiding the risk of overdiagnosis in gastric cancer patients with sarcoidosis.
结节病是一种伴有非干酪样肉芽肿的特发性全身性疾病,据报道可与各种恶性肿瘤同时发生。我们在此报告一例患有结节病的进展期胃癌病例,该病例术前难以进行精确诊断。一名69岁女性被诊断为进展期胃癌,因为多层螺旋计算机断层扫描和氟脱氧葡萄糖正电子发射断层扫描检测到多个腹内和胸内淋巴结肿大以及脾脏的肿瘤性病变。然而,这些多处变化可能源于结节病,因为多个淋巴结肿大是胃癌的非特异性变化。在获得适当的知情同意后,选择手术以准确确认疾病进展阶段。结果显示这些变化并非转移性的,遂进行了根治性手术。总之,仔细检查和合理的治疗策略对于避免结节病胃癌患者过度诊断的风险很重要。