Department of Gastrointestinal Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
Clin J Gastroenterol. 2020 Oct;13(5):746-753. doi: 10.1007/s12328-020-01143-2. Epub 2020 Jun 7.
A 70-year-old man who had undergone total gastrectomy 15 years ago for mucinous gastric carcinoma on the lesser curvature of the cardia, visited our hospital complaining of cough. Chest X-ray showed a right hilar shadow and an infiltrative shadow in the left middle lung field, which was not seen in the previous year. Whole-body positron emission tomography-computed tomography (CT) revealed abnormal uptake in the irregular consolidation of the left lung, enlarged right hilar lymph nodes, and a mass lesion on the right adrenal gland. Advanced primary lung adenocarcinoma with multi-organ metastasis was suspected and a CT-guided percutaneous lung biopsy was performed. Histopathological examination showed immunostaining patterns in complete accordance with those of the resected specimen of stomach, and the diagnosis of late recurrence of gastric carcinoma was confirmed. Pulmonary metastasis might have occurred as a direct hematogenous metastasis rather than through the liver. He achieved 31 months survival after the diagnosis receiving some sequences of chemotherapy. Late recurrence over 10 years after gastrectomy is extremely rare and significant predictive factors of late recurrence are not known. We hope that this case will help in detecting significant factors predictive of late recurrence after gastrectomy for gastric carcinoma.
一位 70 岁男性，15 年前因胃贲门部黏液腺癌行全胃切除术，因咳嗽来我院就诊。胸部 X 线片显示右肺门影和左肺中叶浸润性阴影，而去年未见到这些阴影。全身正电子发射断层扫描-计算机断层扫描（CT）显示左肺不规则实变区摄取异常，右肺门淋巴结肿大，右肾上腺有肿块病变。疑似晚期原发性肺腺癌伴多器官转移，行 CT 引导下经皮肺活检。组织病理学检查显示免疫染色模式与胃切除标本完全一致，确诊为胃癌晚期复发。肺转移可能是直接血行转移，而不是通过肝脏。诊断后他接受了几个疗程的化疗，生存了 31 个月。胃癌全胃切除术后 10 年以上的晚期复发极为罕见，晚期复发的显著预测因素尚不清楚。我们希望这个病例有助于发现胃癌全胃切除术后晚期复发的显著预测因素。
