Shimizu Masaki, Mori Takuji, Hirooka Norifumi, Shirota Tetsuya, Ogawa Minoru
Department of Surgery, Tane General Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2019;116(4):336-343. doi: 10.11405/nisshoshi.116.336.
A 69-year-old man was brought to our hospital's emergency room with a chief complaint of hematemesis, which had been caused by advanced gastric cancer on the lesser curvature of the stomach's upper body. Subsequently, total gastrectomy with lymph node dissection (D2) was performed. A pathological diagnosis of gastric adenocarcinoma, U, Less, type 2, 100×70mm, tub2, pT3, int, INFb, ly0, v0, pN0 (0/24), pPM0 (30mm), pDM0 (30mm), fStage IIA, was then established. After discharge, the patient was treated with S-1 as adjuvant chemotherapy at a dose of 120mg per day. However, a decrease in the platelet count prompted termination of chemotherapy, which lasted for three courses. Ten months after surgery, serum CEA levels increased to 116.6ng/ml, with enhanced CT showing a solitary splenic tumor with a diameter of 48×52mm suggestive of gastric cancer recurrence. PET/CT revealed no other tumors suggestive of gastric cancer recurrence. Given that only a solitary splenic metastatic tumor was detected, splenectomy was performed eleven months after surgery. Histological findings were the same as the previous gastric cancer, with peritoneal washing cytology being suspicious. Chemotherapy with the SOX regimen (S-1 at a dose of 120mg per day and oxaliplatin at a dose of 100mg/m) was then started. The patient remained recurrence-free for a half year. Except during the terminal phase, only a few cases of a splenic metastasis from gastric cancer have been reported. We consider splenectomy to be potentially useful for patients with a solitary splenic metastasis from gastric cancer, through which prolonged prognosis could be expected.
一名69岁男性因呕血被送至我院急诊室，呕血由胃体小弯侧进展期胃癌引起。随后进行了全胃切除术及淋巴结清扫（D2）。术后病理诊断为胃腺癌，U，Less，2型，100×70mm，tub2，pT3，int，INFb，ly0，v0，pN0（0/24），pPM0（30mm），pDM0（30mm），fStage IIA。出院后，患者接受S-1辅助化疗，剂量为每日120mg。然而，血小板计数下降促使化疗终止，化疗共进行了三个疗程。术后十个月，血清癌胚抗原（CEA）水平升至116.6ng/ml，增强CT显示脾脏有一个直径48×52mm的孤立性肿瘤，提示胃癌复发。正电子发射断层显像/X线计算机体层成像（PET/CT）未发现其他提示胃癌复发的肿瘤。鉴于仅检测到一个孤立性脾脏转移瘤，术后十一个月进行了脾切除术。组织学检查结果与之前的胃癌相同，腹腔冲洗细胞学检查结果可疑。随后开始采用SOX方案化疗（S-1剂量为每日120mg，奥沙利铂剂量为100mg/m）。患者半年内无复发。除终末期外，仅有少数胃癌脾脏转移的病例报道。我们认为脾切除术对胃癌孤立性脾脏转移患者可能有用，有望延长患者预后。
