Kanazawa Yoshikazu, Kato Shunji, Fujita Itsuo, Onodera Hiroyuki, Takata Hideyuki, Onda Munehiko, Naito Zenya, Uchida Eiji
Department of Surgery, Nippon Medical School, Tokyo, Japan.
J Nippon Med Sch. 2013;80(4):318-23. doi: 10.1272/jnms.80.318.
We report a case of advanced stomach cancer metastatic to the spermatic cord 1 year after curative distal gastrectomy. The patient underwent distal gastrectomy with D2 lymph node dissection. There was no metastasis to the liver or peritoneum, and cytologic examination of the peritoneal lavage fluid was negative for cancer cells (CY0). Histological examination revealed a moderately differentiated tubular adenocarcinoma that had penetrated the serosa (T4a). Postoperative staging was T4aN1M0, stage IIIA, according to the Japanese gastric carcinoma classification scale. One year after the operation, the patient was readmitted with right groin pain. Percutaneous fine needle aspiration biopsy of the inguinal tumor revealed a tubular adenocarcinoma. Extirpation of the inguinal tumor with wedge resection of the right iliac-femoral vein was performed. Pathological examination revealed a moderately differentiated tubular adenocarcinoma that had diffusely infiltrated the connective tissue surrounding the spermatic cord. Immunohistochemical studies showed the tumor cells were reactive for CK7 but not for CK20. These findings were consistent with the diagnosis of a spermatic cord tumor metastatic from a known gastric primary cancer. Laparoscopic exploration showed invagination of the peritoneum with small nodules from the median umbilical fold to the lateral umbilical fold and a markedly decreased distance between the folds. Pathological examination in this area revealed a tubular structure consisting of mesothelial cells within the cancer tissue which was associated with dense fibrosis, suggesting that the invagination of the peritoneum had been caused by minimal peritoneal metastasis.
我们报告一例根治性远端胃切除术后1年发生精索转移的晚期胃癌病例。患者接受了D2淋巴结清扫的远端胃切除术。肝脏或腹膜无转移，腹腔灌洗液的癌细胞细胞学检查为阴性（CY0）。组织学检查显示为中分化管状腺癌，已穿透浆膜（T4a）。根据日本胃癌分类标准，术后分期为T4aN1M0，ⅢA期。术后1年，患者因右腹股沟疼痛再次入院。腹股沟肿瘤的经皮细针穿刺活检显示为管状腺癌。进行了腹股沟肿瘤切除并楔形切除右髂股静脉。病理检查显示为中分化管状腺癌，已弥漫性浸润精索周围的结缔组织。免疫组织化学研究显示肿瘤细胞对CK7呈反应性，但对CK20无反应。这些发现与已知胃原发性癌转移至精索肿瘤的诊断一致。腹腔镜探查显示腹膜内陷，从中脐襞至侧脐襞有小结节，襞间距离明显缩短。该区域的病理检查显示癌组织内由间皮细胞组成的管状结构，伴有致密纤维化，提示腹膜内陷是由微小腹膜转移引起的。
