Ono Kojiro, Takehana Takuo, Yamamoto Kazuhiro, Kawai Shunsuke, Nagase Michitaka
Dept. of Digestive Surgery, Saku Central Hospital Advanced Care Center.
Gan To Kagaku Ryoho. 2019 Jan;46(1):65-69.
A 69-year-old man with chronic gastritis, reflux esophagitis, esophageal hiatal hernia, and history of appendicitis surgery complained of difficulty swallowing. Upper gastrointestinal endoscopy revealed a 10 cm sized Type 3 gastric cancer. Immunostaining was positive for chromogranin A(2+), synaptophysin(3+), CD56(-), and Ki-67>70%. Contrast computed tomography(CT)showed upper gastric wall thickening, and #1, #3, #7, #8a, and #11p enlarged lymph nodes but no distant metastasis. We diagnosed gastric cancer, UM, Less, Type 3, gastric neuroendocrine carcinoma, cT4aN3M0P0CY0, Stage ⅢC. We administered 2 courses of CDDP plus CPT-11 chemotherapy, and a partial response was obtained for the primary gastric lesion and lymph node metastases. We subsequently performed open distal gastrectomy, D2 lymph node dissection, and splenectomy. Pathological examination confirmed that the lesion was gastric cancer, U, Less, Type 3, gastric neuroendocrine carcinoma, MP, Ul-Ⅱ(+), int, INF b, ly2, v0, PM0, DM0, R0, ypT2N2, Stage ⅡB, with a therapeutic value of Grade 2. The patient was discharged on day 15 after the surgery and received 2 courses of adjuvant chemotherapy with CDDP plus CPT-11. Nine months after the surgery, metastasis of the left adrenal grand was found. We performed open left adrenal gland resection and administered adjuvant S-1 chemotherapy.
一名69岁男性，有慢性胃炎、反流性食管炎、食管裂孔疝及阑尾炎手术史，主诉吞咽困难。上消化道内镜检查发现一个10厘米大小的3型胃癌。免疫组化染色显示嗜铬粒蛋白A（2+）、突触素（3+）、CD56（-）、Ki-67>70%呈阳性。增强计算机断层扫描（CT）显示胃壁上部增厚，1、3、7、8a和11p区淋巴结肿大，但无远处转移。我们诊断为胃癌，UM，低分化，3型，胃神经内分泌癌，cT4aN3M0P0CY0，ⅢC期。我们给予2个疗程的顺铂加伊立替康化疗，原发胃病变和淋巴结转移灶获得部分缓解。随后我们进行了开放远端胃切除术、D2淋巴结清扫术和脾切除术。病理检查证实病变为胃癌，U，低分化，3型，胃神经内分泌癌，MP，Ul-Ⅱ（+），int，INF b，ly2，v0，PM0，DM0，R0，ypT2N2，ⅡB期，治疗价值为2级。患者术后第15天出院，并接受了2个疗程的顺铂加伊立替康辅助化疗。术后9个月，发现左肾上腺转移。我们进行了开放左肾上腺切除术并给予辅助S-1化疗。
