Kurebayashi Marie, Hashimoto Akira, Ikenoyama Youhei, Tahara Yuichi, Fuke Hiroyuki, Shimizu Atsuya, Kondo Masahide, Nakano Hiroshi, Kosaka Toshiya
Department of Internal Medicine, Saiseikai-Matsusaka General Hospital.
Department of Neurology, Saiseikai-Matsusaka General Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2018;115(8):755-759. doi: 10.11405/nisshoshi.115.755.
A 78-year-old woman had undergone total gastrectomy and chemotherapy for gastric cancer (pT4N3bM0 Stage IIIC, poorly differentiated adenocarcinoma). She received S-1 monotherapy 3 times weekly (S-1 at 80mg twice daily for 14 days, every 3 weeks). She underwent routine examinations, including tumor markers and computed tomography. She had no signs of recurrent disease, but she suffered from a loss of eyesight 2 years and 8 months after the operation. A choked disc was found, but she had no headaches, nausea, or unconsciousness, which indicated high intraventricular pressure. Enhanced T2-weighted magnetic resonance imaging showed high intensity around the optic nerve. We performed cerebrospinal fluid cytological analysis, which showed poorly differentiated adenocarcinoma. She was diagnosed as having leptomeningeal carcinomatosis of gastric cancer. The patient chose best supportive care and died 2 months after symptoms appearance. Histological analysis during the autopsy showed moderately to poorly differentiated adenocarcinoma. The carcinoma had also infiltrated the spinal cord, peritoneum, and adrenal glands. Histologically, the carcinoma had infiltrated the optic nerve, which caused loss of eyesight. We have not yet established effective therapies for leptomeningeal carcinomatosis, and the prognosis is poor. Leptomeningeal carcinomatosis of gastric cancer that appears by loss of eyesight is very rare. This case illustrates that the possibility of leptomeningeal carcinomatosis should be considered when we treat patients with loss of eyesight of an unknown cause after surgery.
一名78岁女性因胃癌（pT4N3bM0 III期C组，低分化腺癌）接受了全胃切除术和化疗。她接受S-1单药治疗，每周3次（S-1每日80mg，分两次服用，共14天，每3周重复一次）。她接受了包括肿瘤标志物和计算机断层扫描在内的常规检查。她没有复发疾病的迹象，但在术后2年8个月出现了视力丧失。发现视乳头水肿，但她没有头痛、恶心或意识丧失，提示存在高颅内压。增强T2加权磁共振成像显示视神经周围呈高强度信号。我们进行了脑脊液细胞学分析，结果显示为低分化腺癌。她被诊断为胃癌脑膜转移。患者选择了最佳支持治疗，并在症状出现后2个月死亡。尸检时的组织学分析显示为中分化至低分化腺癌。肿瘤还浸润了脊髓、腹膜和肾上腺。组织学检查显示肿瘤浸润了视神经，导致视力丧失。我们尚未确立针对脑膜转移的有效治疗方法，且预后较差。因视力丧失而出现的胃癌脑膜转移非常罕见。该病例表明，在治疗术后出现不明原因视力丧失的患者时，应考虑脑膜转移的可能性。
