Kostoglou Aikaterini, Tzanakis Nikolaos, Epaggelis Ioannis, Vlasis Konstantinos, Skandalakis Panagiotis, Filippou Dimitrios
General Hospital Asklepieio Voulas, 2nd Surgical Department, Voula, Athens, Greece; University of Athens, Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens, Greece.
General Hospital Asklepieio Voulas, 2nd Surgical Department, Voula, Athens, Greece.
Int J Surg Case Rep. 2019;57:110-112. doi: 10.1016/j.ijscr.2019.02.048. Epub 2019 Mar 18.
The present study reports a case of signet-ring gastric adenocarcinoma with isolated cerebellum metastasis 2 years after gastrectomy.
Brain metastases originating from gastric cancer are rare accounting for 2.1-3.3% of all brain tumors registered in Japan. There are no established therapeutic strategies for brain metastases, which accordingly have a poor prognosis. We present here a 69 year old female patient who was diagnosed with solitary cerebellum metastasis 2 years after treatment for gastric adenocarcinoma. The primary gastric cancer was treated by laparotomy with distal gastrectomy and D2 lymphadenectomy. It was diagnosed as a signet ring gastric adenocarcinoma on histopathological examination of the surgical specimen. Two years postoperatively the patient reported back to our clinic complaining of vomiting, persistent headache and instability. MRI of the head showed an enhanced tumor in the left hemisphere of cerebellum and surrounding edematous changes on T1-enhanced imaging. Given the medical history brain metastasis was the first thought in differential diagnosis. Surgical resection was chosen as treatment.
Until recently there are only two large studies that refer to metastatic brain tumors from primary gastric cancer. Besides that, official treatment guidelines for these cases do not exist. Treatment options include surgical resection (SR), whole brain radiotherapy (WBRT), steroids, chemotherapy or a combination.
A solitary cerebellum metastasis from primary gastric adenocarcinoma is a very rare presentation. Early detection of metastatic lesion and successful treatment is challenging.
本研究报告了一例胃印戒细胞腺癌患者，在胃切除术后2年出现孤立性小脑转移。
胃癌脑转移罕见，在日本登记的所有脑肿瘤中占2.1 - 3.3%。目前尚无针对脑转移的既定治疗策略，因此其预后较差。我们在此介绍一名69岁女性患者，她在接受胃腺癌治疗2年后被诊断为孤立性小脑转移。原发性胃癌通过剖腹手术行远端胃切除术和D2淋巴结清扫术进行治疗。手术标本的组织病理学检查诊断为胃印戒细胞腺癌。术后两年，患者回到我们诊所，主诉呕吐、持续性头痛和行走不稳。头部MRI显示小脑左半球有强化肿瘤，T1增强成像上有周围水肿改变。鉴于病史，鉴别诊断首先考虑脑转移。选择手术切除作为治疗方法。
直到最近，仅有两项大型研究提及原发性胃癌的转移性脑肿瘤。除此之外，尚无针对这些病例的官方治疗指南。治疗选择包括手术切除（SR）、全脑放疗（WBRT）、类固醇、化疗或联合治疗。
原发性胃腺癌的孤立性小脑转移是一种非常罕见的表现。早期发现转移病灶并成功治疗具有挑战性。
