Tsukamoto Tadashi, Togano Shingo, Edagawa Eijiro, Kaizaki Ryoji, Hori Takaaki, Takatsuka Satoshi
Dept. of Surgery, Osaka City Juso Hospital.
Gan To Kagaku Ryoho. 2019 Jan;46(1):103-105.
A 68-year-old man presented with generalfatigue due to anemia. Gastrointestinalendoscopy showed a tumor approximately 60mm in diameter in the lesser curvature of the angle of the stomach. Large cell neuroendocrine carcinoma was diagnosed by biopsy of a tumor specimen. Computed tomography revealed bulky regional lymph node metastases, solitary liver metastasis, and left adrenal metastasis. After three courses of combined chemotherapy with S-1 and CDDP, the gastric lesion and lymph node metastases shrunk, but the liver metastasis and left adrenal metastasis enlarged. After three courses of combined chemotherapy with ramucirumab and paclitaxel, the liver metastasis and left adrenal metastasis also shrunk, and no other new metastatic lesions appeared. Accordingly, total gastrectomy with lymph nodes dissection, partial resection of the liver and left adrenalectomy were performed for a curative resection. The histological findings revealed neuroendocrine carcinoma and adenocarcinoma of the stomach. The lesions of the liver and lymph nodes were all burned out, and a tiny metastatic lesion of neuroendocrine carcinoma was left in the left adrenal gland. S-1 was administrated for 3 months after surgery. The patient has been alive for 16months without recurrence after surgery.
一名68岁男性因贫血出现全身乏力。胃肠内镜检查显示胃角小弯处有一个直径约60mm的肿瘤。通过肿瘤标本活检诊断为大细胞神经内分泌癌。计算机断层扫描显示有大量区域淋巴结转移、孤立性肝转移和左肾上腺转移。在接受三疗程S-1与顺铂联合化疗后，胃部病变和淋巴结转移缩小，但肝转移和左肾上腺转移增大。在接受三疗程雷莫西尤单抗与紫杉醇联合化疗后，肝转移和左肾上腺转移也缩小，且未出现其他新的转移病灶。因此，为进行根治性切除，实施了全胃切除加淋巴结清扫、肝部分切除和左肾上腺切除术。组织学检查结果显示为胃神经内分泌癌和腺癌。肝脏和淋巴结的病灶均消失，左肾上腺残留一个微小的神经内分泌癌转移病灶。术后给予S-1治疗3个月。患者术后存活16个月，无复发。
