Namikawa Tsutomu, Tsuda Sachi, Fujisawa Kazune, Munekage Eri, Iwabu Jun, Uemura Sunao, Tsujii Shigehiro, Maeda Hiromichi, Kitagawa Hiroyuki, Kumon Tatsuya, Nagata Yusuke, Kobayashi Michiya, Hanazaki Kazuhiro
Dept. of Surgery, Kochi Medical School.
Gan To Kagaku Ryoho. 2018 Dec;45(13):1827-1829.
A 50-year-old man was referred to our hospital with gastric cancer. Esophagogastroduodenoscopy(EGD)revealed an irregular nodular lesion with an ulcer in the esophagogastric junction, the biopsy specimens of which showed moderately differentiated adenocarcinoma. Abdominal computed tomography(CT)showed a lymph node measuring 1.2 cm in the perigastric area. A clinical diagnosis of advanced gastric cancer was made, and the patient underwent total gastrectomy with D2 lymphadenectomy followed by Roux-en-Y reconstruction. Microscopic examination confirmed that the moderately differentiated adenocarcinoma invaded the muscularis propria with 1 lymph node metastasis and lymphovascular invasion. The final diagnosis according to the Japanese classification of gastric carcinoma was UE, Less, Type 2, 3.8×1.7 cm, T2(MP), M0, H0, P0, N1(1/15), tub2, ly1, v2, StageⅡ. The postoperative course was uneventful, and he received postoperative adjuvant chemotherapy with S-1. The patient underwent periodic follow-up physical examinations, and 1 year after the surgery, CT showed a well-defined mass measuring 1.0 cm in diameter located in the middle lobe of the right lung. Because there was no evidence of further metastatic lesions in any other organs, he underwent surgical resection of the solitary pulmonary lesion by video-assisted thoracic surgery. Pathological examination confirmed the presence of moderately differentiated adenocarcinoma, and the proliferating tumor cells were positive for cytokeratin(CK)7 and CK20, and negative for thyroid transcription factor 1, which confirmed metastasis from gastric cancer. After the surgery, the patient received combination chemotherapy with S-1 plus cisplatin, followed by S-1 monotherapy. Five years after pulmonary metastasectomy, we discontinued chemotherapy because of no evidence of recurrence and the patient's wishes. The patient has remained in good health without evidence of recurrence for 7 years following the second surgery. Resection of the metastatic lesion might be a promising treatment for solitary pulmonary metastasis of gastric cancer; however, further investigations involving the accumulation of a large number of cases and prospective cohort studies are required to verify the above issue, and future development of multidisciplinary therapy is expected.
一名50岁男性因胃癌转诊至我院。食管胃十二指肠镜检查（EGD）显示食管胃交界处有一个不规则结节性病变伴溃疡，活检标本显示为中分化腺癌。腹部计算机断层扫描（CT）显示胃周区域有一个直径1.2 cm的淋巴结。临床诊断为进展期胃癌，患者接受了D2淋巴结清扫的全胃切除术，随后进行了Roux-en-Y重建术。显微镜检查证实中分化腺癌侵犯固有肌层，有1处淋巴结转移和淋巴管侵犯。根据日本胃癌分类，最终诊断为UE，少，2型，3.8×1.7 cm，T2（MP），M0，H0，P0，N1（1/15），tub2，ly1，v2，Ⅱ期。术后过程顺利，他接受了S-1辅助化疗。患者接受定期随访体检，术后1年，CT显示右肺中叶有一个直径1.0 cm边界清晰的肿块。由于没有证据表明其他任何器官有进一步转移病变，他通过电视辅助胸腔镜手术对孤立性肺病变进行了手术切除。病理检查证实存在中分化腺癌，增殖的肿瘤细胞细胞角蛋白（CK）7和CK20阳性，甲状腺转录因子1阴性，证实为胃癌转移。手术后，患者接受了S-1联合顺铂化疗，随后进行S-1单药治疗。肺转移瘤切除术后5年，由于没有复发证据且患者意愿，我们停止了化疗。第二次手术后7年，患者一直保持健康，没有复发迹象。切除转移灶可能是胃癌孤立性肺转移的一种有前景的治疗方法；然而，需要进一步开展大量病例积累和前瞻性队列研究来验证上述问题，期待多学科治疗的未来发展。
