Nakai Makoto, Ichisawa Aika, Yamada Takahiro, Kimura Toshiro, Yonaiyama Shinnosuke, Jin Hiroyuki, Tokura Tomohisa, Aoki Kazunori, Kawashima Hiroaki, Toyoki Yoshikazu, Endo Masaaki
Dept. of Surgery, Aomori City Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2434-2436.
A 69-year-old man was hospitalized for gastric cancer. He underwent total gastrectomy with distal pancreatectomy, splenectomy, and cholecystectomy. Pathological staging was pT3N3aM0 and Stage ⅢB. Adjuvant chemotherapy(S-1)was administered postoperatively. Ten months later, left adrenal metastasis was detected on computed tomography(CT)scans. He was then treated with 4 courses of chemotherapy with SOX therapy and 2 courses of PTX plus RAM therapy for the left adrenal metastasis. However, the tumor size increased. He underwent adrenalectomy with left nephrectomy and partial resection of the transverse colon for the solitary adrenal metastasis. His pathological diagnosis was metastatic carcinoma of the left adrenal gland and lymph nodes, which invaded the left renal vein and originated from gastric carcinoma. Three months after the adrenalectomy, CT scans identified paraaortic, porta hepatis, and left supraclavicular lymph node metastases. The patient was continuously treated with nivolumab, for 20 courses, and is doing well with good PS. Adrenalectomy for solitary adrenal metastasis of gastric cancer very rarely occurs. We report a case of multiple lymph node metastases treated with nivolumab after an adrenalectomy for solitary adrenal metastasis of gastric cancer after a gastrectomy.
一名69岁男性因胃癌住院。他接受了全胃切除术，同时行远端胰腺切除术、脾切除术和胆囊切除术。病理分期为pT3N3aM0，ⅢB期。术后给予辅助化疗（S-1）。十个月后，计算机断层扫描（CT）发现左肾上腺转移。随后，他接受了4个疗程的SOX方案化疗以及2个疗程的紫杉醇联合雷莫西尤单抗治疗左肾上腺转移瘤。然而，肿瘤大小仍增大。他接受了肾上腺切除术，同时切除左肾并部分切除横结肠以治疗孤立性肾上腺转移瘤。其病理诊断为左肾上腺及淋巴结转移性癌，侵犯左肾静脉，原发于胃癌。肾上腺切除术后三个月，CT扫描发现腹主动脉旁、肝门和左锁骨上淋巴结转移。该患者接受了20个疗程的纳武单抗持续治疗，目前状况良好，体能状态良好。因胃癌孤立性肾上腺转移而行肾上腺切除术的情况极为罕见。我们报告了一例在胃切除术后因胃癌孤立性肾上腺转移而行肾上腺切除术后，采用纳武单抗治疗多发淋巴结转移的病例。
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