Higuchi Ichiro, Akiyama Yousuke, Yamamoto Makoto, Tanigawa Takahiko, Hasuike Yasunori, Miyamoto Makoto
Dept. of Gastroenterological Surgery, Iseikai Hospital.
Gan To Kagaku Ryoho. 2014 Nov;41(12):2422-4.
A 55-year-old man suffering from gastric cancer associated with metastases to the lymph node, gallbladder, and liver was administered chemotherapy with S-1 and cisplatin. Before initiation of therapy, the primary tumor, lymph node metastases, and liver metastases showed fluorodeoxyglucose (FDG) accumulation by positron emission tomography (PET). After 1 course of chemotherapy, the patient received curative surgical treatment including distal gastrectomy, partial hepatectomy, cholecystectomy, and lymph node dissection. The final pathological finding was moderately differentiated adenocarcinoma, T4b(SI), N3a(10/20), P0, CY0, pH1, pM1, Stage IV. Five months after surgery, the serum carcinoembryonic antigen (CEA) level was found to be increasing and PET examination identified an FDG-accumulating nodule in the ascending colon. Colonoscopy identified a submucosal tumor diagnosed as a metastasis from the gastric cancer. Right colectomy was performed 7 months after the first surgery resulting in a curative resection. In each surgery, PET examination indicated that no other distant metastases existed, and curative resection would be possible. Furthermore, although solitary metastatic colorectal lesions are rare, PET examination revealed them accurately. Thus, FDG-PET is very useful for identifying metastases in patients with gastric cancer.
一名55岁患有胃癌且伴有淋巴结、胆囊和肝脏转移的男性接受了S-1和顺铂化疗。在治疗开始前，通过正电子发射断层扫描（PET）发现原发肿瘤、淋巴结转移灶和肝脏转移灶均有氟脱氧葡萄糖（FDG）摄取。化疗1个疗程后，患者接受了包括远端胃切除术、部分肝切除术、胆囊切除术和淋巴结清扫术在内的根治性手术治疗。最终病理结果为中分化腺癌，T4b（SI），N3a（10/20），P0，CY0，pH1，pM1，IV期。术后5个月，发现血清癌胚抗原（CEA）水平升高，PET检查在升结肠发现一个FDG摄取结节。结肠镜检查发现一个黏膜下肿瘤，诊断为胃癌转移。首次手术后7个月进行了右半结肠切除术，实现了根治性切除。在每次手术中，PET检查均表明不存在其他远处转移，可行根治性切除。此外，尽管孤立性结直肠转移病变罕见，但PET检查能准确发现它们。因此，FDG-PET对识别胃癌患者的转移灶非常有用。
