Yamasaki Takahisa, Fukui Hirokazu, Sei Hiroo, Hara Ken, Eda Hirotsugu, Kondo Takashi, Toyoshima Fumihiko, Kono Tomoaki, Tozawa Katsuyuki, Ikehara Hisatomo, Tomita Toshihiko, Oshima Tadayuki, Watari Jiro, Miwa Hiroto
Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Japan.
Intern Med. 2016;55(6):609-11. doi: 10.2169/internalmedicine.55.5129. Epub 2016 Mar 15.
A 35-year-old man was diagnosed to have gastric cancer by endoscopic and histological examinations. Staging laparoscopy detected peritoneal metastasis. Systemic chemotherapy was started, but the patient complained of severe headache. Subsequently, a lumbar puncture demonstrated adenocarcinoma cells in the spinal fluid, suggesting the occurrence of meningeal carcinomatosis (MC) from gastric cancer. MC occurs only rarely in patients with gastric cancer, but the prognosis is invariably poor. However, this patient nevertheless survived for 12 months after receiving intrathecal MTX/Ara-C together with systemic chemotherapy. Therefore, the early detection of meningeal irritation sign and intrathecal chemotherapy might greatly improve the prognosis of gastric cancer patients with MC.
一名35岁男性经内镜和组织学检查被诊断为胃癌。分期腹腔镜检查发现腹膜转移。开始进行全身化疗，但患者主诉严重头痛。随后，腰椎穿刺显示脑脊液中有腺癌细胞，提示发生了胃癌脑膜转移（MC）。MC在胃癌患者中极为罕见，但其预后总是很差。然而，该患者在接受鞘内注射甲氨蝶呤/阿糖胞苷联合全身化疗后仍存活了12个月。因此，早期发现脑膜刺激征和鞘内化疗可能会大大改善胃癌合并MC患者的预后。
